US20210113275A1 - Depth control instrument guide for robotic surgery - Google Patents
Depth control instrument guide for robotic surgery Download PDFInfo
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- US20210113275A1 US20210113275A1 US17/070,547 US202017070547A US2021113275A1 US 20210113275 A1 US20210113275 A1 US 20210113275A1 US 202017070547 A US202017070547 A US 202017070547A US 2021113275 A1 US2021113275 A1 US 2021113275A1
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Definitions
- This document pertains generally, but not by way of limitation, to devices and methods for robot-assisted surgical procedures, such those involving the use of articulating robotic arms that can be moved about multiple axes. More specifically, but not by way of limitation, the present application relates to holders and guides that can be used to position instruments relative to a robotic arm.
- Imaging of anatomical features can be useful in preparing for and performing surgical procedures.
- it can be desirable to register the shape of the anatomy in the obtained images with another frame of reference, such as the physical space of an operating room.
- the physical space of the operating room can be correlated to a frame of reference for a robotic surgical system.
- Robotic surgical arms are used to hold various instruments in place in a desired orientation relative to both the anatomy and operating room during a procedure so that movement of an instrument in the operating room relative to the anatomy can be tracked on the anatomic imaging based on movement of the robotic surgical arm. It is, therefore, desirable to precisely mount instruments to the robotic surgical arm.
- Means for measuring a position of an instrument relative to an instrument holder are described in Pub. No. WO 2015/061638 A1 to Crawford et al.
- problems to be solved with traditional robotic instrument holders can include knowing the relative position of an instrument within an instrument holder relative to a robotic arm holding the instrument.
- problems to be solved with traditional robotic instrument holders can include knowing the relative position of an instrument within an instrument holder relative to a robotic arm holding the instrument.
- surgeons use guide tubes or other devices that are mounted to a robotic surgical arm. Once the instrument is aligned along the desired trajectory, the robotic arm becomes immobilized and the instrument is moved along the trajectory through the instrument holder. Since the robot arm is not moving and the instrument is not attached on it, the precise position of the instrument cannot be determined via the location of the robotic arm.
- Previous attempts to determine the position of the instrument include attaching a tracking device to the instrument that can be tracked in a coordinate system synched to the coordinate system of the robotic arm.
- optical navigation systems require line-of-sight with the instrument to be maintained in order to obtain accurate position information.
- Other attempts to determine position of an instrument relative to the instrument holder involve using sensors in the instrument holder that read information off the instrument, as are described in the aforementioned publication to Crawford et al.
- Such systems require the use instruments that are compatible with the sensor.
- the instrument typically must include appropriate visual indicia (e.g., coated markers such as contrast or color marks or gradients) for optical reading or include metallic indicia (e.g., embedded magnetic strips or coils) for magnetic reading.
- visual indicia e.g., coated markers such as contrast or color marks or gradients
- metallic indicia e.g., embedded magnetic strips or coils
- the present subject matter can provide a solution to these and other problems, such as by providing an instrument holder having a measuring device that can determine position information of conventional instruments and non-conventional instruments (e.g., those including visual or magnetic indicia). More particularly, the present subject matter can provide an instrument holder that includes a mechanical or electro-mechanical device for determining position of the instrument independent of features of the instrument in order to accommodate off-the-shelf and conventional (e.g., non-marked) instrumentation.
- the present subject matter relates to medical instrument holder devices, such as for robotic surgical systems, that have mechanical or electro-mechanical position readers or sensors that can physically contact or engage the instrument while the instrument is inserted in or proximate to the position holder.
- the medical instrument holder devices of the present disclosure facilitate reading position information from any type of instrument without requiring special instruments compatible with the mechanical or electro-mechanical position reader.
- the position readers allow for precise alignment of the instrument relative to the position holder, thereby allowing the depth that a tip of an instrument is extended beyond the instrument holder, e.g., into a patient to be known and correlated to a coordinate system of the robotic surgical system,
- an instrument holder system can comprise a guide body and a mechanical or electro-mechanical measuring device.
- the guide body can comprise a first end, a second end, and a passage extending between the first and second ends along an axis to receive an instrument.
- the measuring device can comprise an attachment body for coupling to the guide body, a probe configured to extend into a trajectory of the passage to contact the instrument and generate positional data and, optionally, a control device coupled to the probe and configured to receive the positional data.
- a method of determining a position of a surgical instrument relative to an instrument holder for a robotic surgical system can comprise inserting the surgical instrument into a passage of the instrument holder, moving the instrument into contact with a sensing element, moving a tip of the instrument out of the instrument holder to cause movement of the sensing element, and correlating movements of the sensing element to distances the tip extends out of the instrument holder.
- FIG. 1 is a diagrammatic view of an operating room including a robot-assisted surgical system comprising a robotic arm, a computing system and a tracking system.
- FIG. 2 is a schematic view of the robotic arm of FIG. 1 including an instrument holder configured to support or guide an instrument along an axis with a depth control device.
- FIG. 3 is a perspective view of an instrument holder having a depth control device for aligning and holding in-place various medical instruments during surgeries performed with a surgical robot, such as the robot-assisted surgical system of FIGS. 1 and 2 .
- FIG. 4 is a perspective exploded view of a guide body, instrument adapter and an instrument of the instrument holder of FIG. 3 .
- FIG. 5 is a perspective view of a calibration module of the instrument holder of FIG. 3 .
- FIG. 6 is a perspective exploded view of a measuring device of the instrument holder of FIG. 3 .
- FIG. 7 is a side view of the instrument holder of FIG. 3 attached to the robotic arm of FIGS. 1 and 2 and showing the instrument inserted through the guide body to engage the calibration module.
- FIG. 8 is a side cross-sectional view of the instrument holder of FIG. 7 with the calibration module removed.
- FIG. 9 is a schematic illustration showing the depth control device of the instrument holder of FIG. 3 being calibrated in an operating room environment.
- FIG. 10 is a schematic illustration showing the depth control device of the instrument holder of FIG. 3 being used to guide an instrument into engagement with a patient in the operating room environment.
- FIG. 11 is a schematic illustration showing an additional embodiment of the instrument holder described herein including multiple measuring devices.
- FIG. 12 is a schematic illustration of a position measuring device for use with compatible instruments via engagement of a rack and pinion engagement system.
- FIG. 13 is a flow chart illustrating steps of methods for assembling an instrument holder with a measuring device and a robotic surgical system, calibrating the measuring device of the instrument holder and using the instrument holder with the measuring device.
- FIG. 14 is a schematic illustration of a robotic surgical system incorporating an instrument holder having a depth control device of the present application interacting with a tracking system.
- FIG. 15 is a schematic illustration of a block diagram of an example machine upon which any one or more of the techniques discussed herein may perform and with which any of the devices discussed herein may be used in accordance with some embodiments.
- FIG. 1 illustrates surgical system 100 for operation on surgical area 105 of patient 110 in accordance with at least one example of the present disclosure.
- Surgical area 105 in one example can include a joint and, in another example, can be a bone.
- Surgical area 105 can include any surgical area of patient 110 , including but not limited to the shoulder, head, elbow, thumb, spine, and the like.
- Surgical system 100 can also include robotic system 115 with one or more robotic arms, such as robotic arm 120 . As illustrated, robotic system 115 can utilize only a single robotic arm.
- Robotic arm 120 can be a 6 degree-of-freedom (DOF) robot arm, such as the ROSA® robot from Medtech, a Zimmer Biomet Holdings, Inc.
- DOF 6 degree-of-freedom
- robotic arm 120 is cooperatively controlled with surgeon input on the end effector or surgical instrument, such as surgical instrument 125 .
- robotic arm 120 can operate autonomously. While not illustrated in FIG. 1 , one or more positionable surgical support arms can be incorporated into surgical system 100 to assist in positioning and stabilizing instruments or anatomy during various procedures.
- Surgical instrument 125 can be any surgical instrument adapted for use by the robotic system 115 , including, for example, a guide tube, a holder device, a gripping device such as a pincer grip, a burring device, a reaming device, an impactor device such as a humeral head impactor, a pointer, a probe or the like.
- Surgical instrument 125 can be positionable by robotic arm 120 , which can include multiple robotic joints, such as joints 135 , that allow surgical instrument 125 to be positioned at any desired location adjacent or within a given surgical area 105 .
- robotic arm 120 can be used with an instrument positioning device, e.g., instrument holder 200 ( FIG. 2 ), to position an instrument in a known, desired or predetermined orientation relative to surgical area 105 based on a virtual coordinate system determined by computing system 140 .
- instrument positioning device e.g., instrument holder 200 ( FIG. 2 )
- Robotic system 115 can also include computing system 140 that can operate robotic arm 120 and surgical instrument 125 .
- Computing system 140 can include at least memory, a processing unit, and user input devices, as will be described herein.
- Computing system 140 and tracking system 165 can also include human interface devices 145 for providing images for a surgeon to be used during surgery.
- Computing system 140 is illustrated as a separate standalone system, but in some examples computing system 140 can be integrated into robotic system 115 .
- Human interface devices 145 can provide images, including but not limited to three-dimensional images of bones, glenoid, joints, and the like.
- Human interface devices 145 can include associated input mechanisms, such as a touch screen, foot pedals, or other input devices compatible with a surgical environment.
- Computing system 140 can receive pre-operative, intra-operative and post-operative medical images. These images can be received in any manner and the images can include, but are not limited to, computed tomography (CT) scans, magnetic resonance imaging (MRI), two-dimensional x-rays, three-dimensional x-rays, ultrasound, and the like. These images in one example can be sent via a server as files attached to an email. In another example the images can be stored on an external memory device such as a memory stick and coupled to a USB port of the robotic system to be uploaded into the processing unit. In yet other examples, the images can be accessed over a network by computing system 140 from a remote storage device or service.
- CT computed tomography
- MRI magnetic resonance imaging
- two-dimensional x-rays two-dimensional x-rays
- three-dimensional x-rays three-dimensional x-rays
- ultrasound and the like.
- images in one example can be sent via a server as files attached to an email.
- the images can be stored on an external memory
- computing system 140 can generate one or more virtual models related to surgical area 105 .
- computer system 140 can receive virtual models of the anatomy of the patient prepared remotely.
- a virtual model of the anatomy of patient 110 can be created by defining anatomical points within the image(s) and/or by fitting a statistical anatomical model to the image data.
- the virtual model, along with virtual representations of implants, can be used for calculations related to the desired height, depth, inclination angle, or version angle of an implant, stem, surgical instrument, or the like related to be utilized in surgical area 105 .
- the virtual model can be utilized to determine insertion location, trajectory and depth for inserting an instrument.
- the virtual model can also be used to determine bone dimensions, implant dimensions, bone fragment dimensions, bone fragment arrangements, and the like. Any model generated, including three-dimensional models, can be displayed on human interface devices 145 for reference during a surgery or used by robotic system 115 to determine motions, actions, and operations of robotic arm 120 or surgical instrument 125 .
- Known techniques for creating virtual bone models can be utilized, such as those discussed in U.S. Pat. No. 9,675,461, titled “Deformable articulating templates” or U.S. Pat. No. 8,884,618, titled “Method of generating a patient-specific bone shell” both by Mohamed Rashwan Mahfouz, as well as other techniques known in the art.
- Computing system 140 can also communicate with tracking system 165 that can be operated by computing system 140 as a stand-alone unit.
- Surgical system 100 can utilize the Polaris optical tracking system from Northern Digital, Inc. of Waterloo, Ontario, Canada.
- tracking system 165 can comprise the tracking system shown and described in Pub. No. US 2017/0312035, titled “Surgical System Having Assisted Navigation” to Brian M. May, which is hereby incorporated by this reference in its entirety.
- Tracking system 165 can monitor a plurality of tracking elements ; such as tracking elements 170 ; affixed to objects of interest to track locations of multiple objects within the surgical field.
- Tracking system 165 functions to create a virtual three-dimensional coordinate system within the surgical field for tracking patient anatomy, surgical instruments, or portions of robotic system 115 .
- Tracking elements 170 can be tracking frames including multiple IR reflective tracking spheres, or similar optically tracked marker devices.
- tracking elements 170 can be placed on or adjacent one or more bones of patient 110 .
- tracking elements 170 can be placed on robot robotic arm 120 , surgical instrument 125 , and/or an implant to accurately track positions within the virtual coordinate system associated with surgical system 100 .
- tracking elements 170 can provide position data, such as patient position, bone position, joint position, robotic arm position, implant position, or the like.
- Robotic system 115 can include various additional sensors and guide devices.
- robotic system 115 can include one or more force sensors, such as force sensor 180 .
- Force sensor 180 can provide additional force data or information to computing system 140 of robotic system 115 .
- Force sensor 180 can be used by a surgeon to cooperatively move robotic arm 120 .
- force sensor 180 can be used to monitor impact or implantation forces during certain operations, such as insertion of an implant stem into a humeral canal. Monitoring forces can assist in preventing negative outcomes through force fitting components.
- force sensor 180 can provide information on soft-tissue tension in the tissues surrounding a target joint.
- robotic system 115 can also include laser pointer 185 that can generate a laser beam or array that is used for alignment of implants during surgical procedures.
- the space of surgical area 105 and patient 110 can be registered to computing system 140 via a registration process involving registering fiducial markers attached to patient 110 with corresponding images of the markers in patient 110 recorded preoperatively or just prior to a surgical procedure.
- a plurality of fiducial markers can be attached to patient 110 , images of patient 110 with the fiducial markers can be taken or obtained and stored within a memory device of computing system 140 .
- patient 110 with the fiducial markers can be moved into, if not already there because of the imaging, surgical area 105 and robotic arm 120 can touch each of the fiducial markers.
- engagement of each of the fiducial markers can be cross-referenced with, or registered to, the location of the same fiducial marker in the images.
- patient 110 and medical images of the patient can be registered in real space using contactless methods, such as by using a laser rangefinder held by robotic arm 120 and a surface matching algorithm that can match the surface of the patient from scanning of the laser rangefinder and the surface of the patient in the medical images.
- the real-world, three-dimensional geometry of the anatomy attached to the fiducial markers can be correlated to the anatomy in the images and movements of instruments 125 attached to robotic arm 120 based on the images will correspondingly occur in surgical area 105 .
- robotic arm 120 can be coupled to an instrument holder including a depth control device of the present disclosure.
- Robotic arm 120 can move the instrument holder and depth control device into different positions relative to anatomy of the patient such that an axis of the adjustable instrument holder extends along a desired orientation relative to the anatomy.
- the depth control devices of the present application can enable surgical system 100 to know the location of an instrument relative to the instrument holder so that the precise position of the instrument relative to robotic arm 120 can be determined, without the use of an optical tracking system of manual efforts.
- FIG. 2 is a schematic view of robotic arm 120 of FIG. 1 including instrument holder 200 , can be positioned by robotic arm 120 relative to surgical area 105 (FIG, 1 ) in a known orientation.
- Instrument holder 200 can comprise guide body 202 and measuring device 204 .
- Passage 206 can extend through guide body 202 and measuring device 204 along axis 208 .
- Instrument holder 200 can be coupled to robotic arm 120 via extension 210 and mounting plate 212 .
- Robotic arm 120 can include joint 135 A that permits rotation about axis 216 A, joint 135 B that can permit rotation about axis 216 B, joint 135 C that can permit rotation about axis 216 C and joint 135 D that can permit rotation about axis 216 D.
- surgical system 100 can manipulate robotic arm 120 automatically by computing system 140 or a surgeon manually operating computing system 140 to move instrument holder 200 to the desired location, e.g., a location called for by a surgical plan to align an instrument relative to the anatomy.
- robotic arm 120 can be manipulated along axes 216 A- 216 D to position passage 208 of instrument holder 200 along a trajectory for which an instrument is to be guided.
- Robotic arm 120 can be separately registered to the coordinate system of surgical system 100 , such via use of a tracking element 170 .
- Fiducial markers can additionally be separately registered to the coordinate system of surgical system 100 via engagement with a probe having a tracking element 170 attached thereto.
- some or all of the components of surgical system 100 can be individually registered to the coordinate system and, if desired, movement of such components can be continuously or intermittently tracked with a tracking element 170 .
- robotic arm 120 can automatically provide a trajectory for an instrument, while the surgeon manually provides the motive force for the instrument.
- the precise location of the instrument e.g., the location of the tip of the instrument in the coordinate system, can become lost or obfuscated, and surgical system 100 will not be able to reproduce the location of said tip in imaging of the patient.
- instruments can be separately tracked using an optical navigation system that, under ideal conditions, alleviate the need for precisely maintaining axis 208 and the location of an instrument along axis 208 through a surgical procedure or surgical task, as the optical navigation system can provide the surgical computer system information to compensate for any changes.
- optical navigation systems require line-of-sight with the instruments to be maintained, there is a significant advantage in not requiring instruments to be navigated (or at least not constantly navigated). Accordingly, the ability to precisely maintain axis 208 and position along axis 208 provides the additional advantage of at least reducing, and possibly eliminating, the need to navigate instruments during a robotic procedure.
- the present application describes various measuring devices (e.g., depth control devices, sensing devices, mechanical position determining devices, electro-mechanical positioning devices) that can determine the position of an instrument relative to an instrument holder without requiring line-of-sight or specialty instruments, such that the position of the instrument relative to robotic arm 120 and the coordinate system can be determined.
- various measuring devices e.g., depth control devices, sensing devices, mechanical position determining devices, electro-mechanical positioning devices
- FIG. 3 is a perspective view of instrument holder 200 comprising guide body 202 and measuring device 204 .
- Passage 206 ( FIG. 2 ) can extend through guide body 202 and measuring device 204 along axis 208 .
- Instrument holder 200 can be coupled to robotic arm 120 via extension 210 and mounting plate 212 .
- Instrument holder 200 can further comprise instrument adapter 214 and calibration module 216 .
- Measuring device 204 and calibration module 216 can be affixed to guide body 202 via fasteners 217 A and 217 B, respectively.
- Measuring device 204 can comprise attachment body 218 , probe 220 and control device 222 .
- Instrument holder 200 can be used in conjunction with instrument 224 .
- Instrument holder 200 and instrument adapter 214 can comprise devices for holding an instrument, such as medical instruments including catheters, cannulas and guidewires.
- Instrument adapter 214 can be configured to be inserted into passage 206 ( FIG. 2 ) of guide body 202 .
- Instrument adapter 214 can include passage 226 for receiving instrument 224 .
- Passage 226 in instrument adapter 214 can be positioned to align with axis 208 ( FIG. 2 ) such that passage 226 and passage 206 are concentric.
- Robotic arm 120 can be configured to position guide body 202 and hence instrument adapter 214 in a fixed orientation such that axis 208 is aligned relative to a patient in a desired orientation, such as an orientation pre-operatively or intra-operatively planned according to a surgical plan.
- Mounting plate 212 can be mounted to robotic arm 120 ( FIG. 2 ) such as by inserting threaded fasteners into bores 228 .
- Extension 210 can be coupled to mounting plate 212 to provide a mounting arm for coupling with instrument holder 200 .
- Extension 210 can include seat 230 having a semi-circular or circular arc length shape to receive and mate with guide body 202 .
- Extension 210 and guide body 202 can be coupled using any suitable means, such as fasteners (e.g., fastener 304 of FIG. 8 ) or metallurgical bonding.
- Extension 210 can extend along an axis that is perpendicular to axis 208 .
- Extension 210 can be configured to align passage 206 extending through guide body 202 at a known position relative to bores 228 such that the position of passage 206 to robotic arm 120 is in a known, e.g., known to computing system 140 , orientation.
- a known position relative to bores 228 such that the position of passage 206 to robotic arm 120 is in a known, e.g., known to computing system 140 , orientation.
- instrument adapter 214 After instrument holder 200 is attached to robotic arm ( FIG. 2 .) via mounting plate 212 , instrument adapter 214 , calibration module 216 and measuring device 204 can be attached to guide body 202 . Instrument adapter 214 , calibration module 216 and measuring device 204 can be assembled to main body 202 in any order. Instrument adapter 214 , calibration module 216 and measuring device 204 can be used to determine the relative position of instrument 224 to instrument holder 200 , such as how far a tip 232 of instrument 224 extends beyond an inferior end, e.g., bottom surface 234 , of main body 202 .
- FIG. 4 is a perspective exploded view of guide body 202 , instrument adapter 214 and instrument 224 of instrument holder 200 of FIG. 3 .
- Guide body 202 can comprise guide tube 240 , mounting flange 242 , bores 244 A and 244 B, top surface 246 and bottom surface 234 .
- Guide tube 240 can define passage 206 .
- Instrument adapter 214 can comprise adapter tube 248 , stop flange 250 , top surface 252 and passage 226 .
- Instrument 224 can comprise shaft 254 , flange 256 and tip 232 .
- Adapter tube 248 can have an outer diameter sized to closely mate with the inner diameter of passage 206 .
- Passage 226 can be centered within adapter tube 248 .
- passage 226 can be positioned concentric with passage 206 via placement of adapter tube 248 within guide tube 240 .
- Stop flange 250 can have a diameter larger than that of passage 206 , and guide tube 240 , to prevent adapter tube 248 from passing completely through guide tube 240 .
- stop flange 250 can rest on a superior end, e.g., top surface 246 , of guide tube 240 .
- adapter tube 248 can be friction-fit into guide tube 240 .
- Adapter tube 248 can be approximately equal in length to guide tube 240 . However, as shown in FIG. 8 , adapter tube 248 can be shorter than guide tube 240 to, for example, not interfere with tip 232 extending below bottom surface 234 .
- Shaft 254 can have an outer diameter sized to closely mate with the inner diameter of passage 226 . As such, shaft 254 can be centered within passage 226 and instrument 224 can be centered within instrument holder 200 . Shaft 254 can be longer than the length of guide tube 240 to allow tip 232 to extend out of, e.g., beyond bottom surface 234 , guide tube 240 . Stop flange 256 can have a diameter larger than that of shaft 254 and passage 226 to prevent instrument 224 from passing completely through instrument adapter 214 . As such, stop flange 256 can rest on a superior end, e.g., top surface 252 , of instrument adapter 214 .
- shaft 254 can be friction-fit into passage 226 such that instrument 224 can remain in place within instrument adapter without shaft 254 freely sliding into passage 226 .
- instrument 224 can be held in-place within instrument adapter 214 in a desired position.
- tip 232 can be held by frictional engagement between shaft 254 and adapter tube 248 inside passage 226 until a surgeon is ready to advance tip 232 toward a patient, such as by manually pushing on flange 256 .
- Mounting flange 242 can extend from bottom surface 234 of guide tube 240 and, as such, can have an outer diameter larger than guide tube 240 .
- Flange 242 can provide a platform for mounting other components to guide body 202 .
- Flange 242 can extend completely around the perimeter of guide tube 240 to allow attachment at any location around the circumference of guide tube 240 .
- mounting flange 242 can include bores 244 A and 244 B to facilitate attachment of additional components at specific locations.
- bores 244 A and 244 B are located at opposing locations on mounting flange 242 , e.g. one-hundred-eighty degrees apart, to receive calibration module 216 and measuring device 204 .
- FIG. 5 is a perspective view of calibration module 216 of instrument holder 200 of FIG. 3 .
- Calibration module 216 can comprise coupling portion 260 , plate 262 and extension 264 .
- Coupling portion 260 can comprise slot 266 and bore 268 .
- Bore 268 can comprise upper and lower portions extending through opposite sides of slot 266 .
- Coupling portion 260 can comprise a flange configured to mate with mounting flange 242 ( FIG. 4 ) of guide body 202 .
- Slot 266 can have a height sufficient to receive mounting flange 242 and that is sufficiently deep to allow one of bores 244 A and 244 B to align with bore 268 . As such, one of fasteners 217 A and 217 B ( FIG.
- Slot 266 and plate 262 can extend in parallel planes. Plate 262 can have a length sufficient to extend from extension 264 to axis 208 ( FIGS. 2 and 3 ) such that plate 262 can oppose passage 226 . Thus, plate 262 can be configured to engage any diameter of instrument that extends from passage 206 , for different sizes of passage 226 of instrument adapter 214 . Extension 264 can extend away from coupling portion 260 to space plate 262 a distance away from slot 266 .
- the distance that plate 262 is positioned away from slot 266 can be a fixed distance that is predetermined and known, e.g., known to computing system 140 (e.g., stored in memory of computing system 140 ). As will be discussed below, plate 262 can be used to zero the position of instrument 224 relative to guide body 202 .
- FIG. 6 is a perspective exploded view of measuring device 204 of instrument holder 200 FIG. 3 .
- Measuring device 204 can comprise a sensing device or depth control device configured to determine or sense the position of instrument 224 relative to guide body 202 , which can be used to control the distance that instrument 224 is extended from guide body 202 , e.g. the depth that instrument is inserted into a patient.
- Measuring device 204 can comprise attachment body 218 , probe 220 and control device 222 .
- Attachment body 218 can comprise coupling portion 270 , sensor bracket 272 , and mounting posts 274 A and 274 B.
- Coupling portion 270 can comprise bores 276 A and 276 B and slot 278 .
- Sensor bracket 272 can comprise bore 280 .
- Probe 220 can comprise wheel 282 , axle 284 , mounting brackets 286 A and 286 B, posts 288 A and 288 B, and springs 290 A and 290 B.
- Control device 222 can comprise housing 292 , tube 294 and sensor 296 .
- Wheel 282 can include hash marks 298 .
- Coupling portion 270 can comprise a flange configured to mate with mounting flange 242 ( FIG. 4 ) of guide body 202 .
- Slot 278 can have a height sufficient to receive mounting flange 242 and that is sufficiently deep to allow one of bores 244 A and 244 B to align with bores 276 A and 276 B.
- one of fasteners 217 A and 217 B ( FIG. 3 ) can be extended through one of bores 244 A and 244 B and bores 276 A and 276 B to secure measuring device 204 to guide body 202 .
- Sensor bracket 272 can extend from coupling portion 270 to position bore 280 and mounting posts 274 A and 274 B in a position to face instrument 224 when extended out of passage 226 beyond bottom surface 234 ( FIG. 3 ), e.g., to oppose extension 264 when both measuring device 204 and calibration module 216 are attached to mounting flange 242 .
- Bore 280 can be configured to receive tube 294 of control device 222 .
- control device 222 can be mounted to an exterior surface of sensor bracket 272 such that tube 294 extends past an interior surface of sensor bracket 272 toward axis 208 ( FIG. 3 ).
- Tube 294 can be threaded into bore 280 or can be held in place by fasteners, e.g., nuts, threaded onto tube 294 .
- Sensor 296 can be located in tube 294 or housing 292 and can be configured to sense or emit signal S ( FIG. 7 ) out of tube 294 toward axis 208 .
- Housing 292 can comprise an enclosure or container to provide support and protection for components of control device 222 .
- power module 300 and transmitter 302 FIG. 8
- Probe 220 can comprise any suitable device for mechanically engaging instrument 224 and providing feedback to control device 222 .
- probe 220 can be configured to make physical contact with instrument 224 .
- probe 220 can comprise wheel 282 rotatable about or on axle 284 .
- wheel 282 can be configured to rotate about an axis perpendicular to axis 208 .
- Mounting brackets 286 A and 286 B can be configured to support wheel 282 via engagement with axle 284 .
- Mounting brackets 286 A and 286 B can be coupled to posts 288 A and 288 B, respectively.
- Springs 290 A and 290 B can be configured to be positioned over posts 288 A and 288 B, respectively.
- Springs 290 A and 290 B and posts 288 A and 288 B can be configured to be inserted into mounting posts 274 A and 274 B, respectively.
- mounting posts 274 A and 274 B can be configured as tubes having inner diameters larger than springs 290 A and 290 B.
- Posts 288 A and 288 B can be configured to slide within mounting posts 274 A and 274 B, respectively, to form a sliding bracket that can allow wheel 282 to be displaceable relative to axis 208 .
- Springs 290 A and 290 B, or any other suitable biasing element, can be configured to bias wheel 282 toward axis 208 .
- Springs 290 A and 290 B, posts 288 A and 288 B and mounting posts 274 A and 274 B can be configured to allow wheel 282 to traverse anywhere between contact of wheel 282 with axis 208 to a distance away from axis 208 to accommodate the largest sized instrument positionable within guide tube 240 .
- wheel 282 can have a stroke length equal to, or greater than, the radius of guide tube 240 .
- Springs 290 A and 290 B, posts 288 A and 288 B and mounting posts 274 A and 274 B can be assembled and secured by any means suitable to allow functionality described herein.
- FIG. 7 is a side view of instrument holder 200 of FIG. 3 attached to robotic arm 120 of FIGS. 1 and 2 and showing instrument 224 inserted through guide body 202 to engage calibration module 216 .
- Plate 262 of calibration module 216 can be positioned opposite guide body 240 such that plate 262 can be engaged by instrument 224 .
- Extension 264 can position plate 262 first distance D 1 from bottom surface 234 .
- Wheel 282 can be configured to contact instrument 224 distance D 2 below bottom surface 234 .
- Distances D 1 and D 2 can be stored in memory of computing system 140 (e.g., memory 622 of FIG. 14 or memories 1704 and 1707 of FIG. 15 ). In the position of instrument 224 of FIG.
- measuring device 204 can be calibrated or zeroed to set the distance of tip 232 . from bottom surface 234 .
- Calibration can comprise a user-interface function where a user of surgical system 100 engages control device 222 or human interface devices 145 ( FIG. 1 ) to record the location of tip 232 at the time of calibration.
- the location of bottom surface 234 can be known by computing system 140 in the coordinate system of surgical system 100 due to, for example, surgical system 100 knowing the location of robotic arm 120 . With measuring device 204 zeroed, computing system 140 can be set to know the location of tip 232 in the same coordinate system.
- Probe 220 can engage, e.g., contact, shaft 254 of instrument 224 to keep track of, e.g., determine and transmit to computing system 140 , the position of tip 232 in the coordinate system as instrument 224 is moved along axis 208 in instrument holder 200 .
- FIG. 8 is a side cross-sectional view of instrument holder 200 of FIG, 7 with calibration module 216 removed. Instrument 224 is moved further into passage 226 relative to the position of instrument 224 of FIG. 8 .
- Control device 222 can comprise housing 292 , tube 294 , sensor 296 , power module 300 and communication device 302 .
- Power module 300 can comprise any suitable device for providing electric power to control device 222 .
- power module 300 can comprise a battery or an AC-to-DC converter for receiving power from an electrical outlet.
- Communication device 302 can comprise any suitable device for receiving information from sensor 296 and conveying the information to outside of control device 222 .
- communication device 302 can include circuitry to perform wireless communications, such as low-energy Bluetooth, near-field communication (NFC), or IEEE 802.11 (Wi-Fi).
- communication device 302 can communicate via wired connection to robotic arm at communication port 306 ( FIG. 7 ), such as a cable connector that can be additionally used for other devices, such as force sensor 180 .
- Sensor 296 can be configured to emit signal S to contact wheel 282 .
- Signal S can be configured as a reader device to read hash marks 298 on wheel 282
- Hash marks 298 can comprise colored markings, e.g., darkened lines, or physical structures, e.g., depressions or protrusions.
- the circumferential distance between hash marks 298 can be stored in memory of computing system 140 , for example, so that surgical system 100 can correlate rotational movement of wheel 282 with linear translation of instrument 224 along axis 208 .
- sensor 296 can comprise a laser emitter.
- Sensor 296 can be configured to count hash marks 298 as hash marks 298 pass through signal S as wheel 282 rotates.
- FIG. 9 is a schematic illustration showing measuring device 204 of instrument holder 200 of FIG. 3 being calibrated in an operating room environment relative to surgeon 310 and patient 312 .
- FIG. 9 illustrates the configuration of instrument holder 200 of FIG. 7 and shows that calibration module 216 and measuring device 204 can remain attached to instrument holder 200 to perform the calibration procedure.
- Robotic arm 120 can be positioned relative to patient 312 to align axis 208 with patient 312 is a desired orientation.
- Surgeon 310 can manually push instrument 224 down to engage plate 262 of calibration module 216 to perform the calibration or zeroing procedure.
- calibration module 216 can be attached to robotic arm 120 and calibrated before robotic arm 120 positions instrument holder 200 in place.
- FIG. 10 is a schematic illustration showing measuring device 204 of instrument holder 200 of FIG. 9 being used to guide an instrument 224 into engagement with patient 312 in the operating room environment.
- FIG. 10 illustrates the configuration of instrument holder 200 of FIG. 8 and shows that calibration module 216 can be removed to allow measuring device 204 to be used to perform a medical procedure. After the calibration procedure has been performed, calibration module 216 can be removed from instrument holder 200 .
- Robotic arm 120 can hold instrument holder 200 in place along the desired trajectory of axis 208 .
- surgeon 310 can manually push instrument into contact with or into patient 312 .
- Measuring device 204 can be used by surgeon 310 to determine, via surgical system 100 , the location of tip 232 .
- Surgeon 310 can then advance instrument 224 according to a surgical plan to a desired depth. For example, surgeon 310 can consult human interface devices 145 to read a distance that tip 232 has been extended, or to view directly, in real time, the insertion of the instrument into a 3D model based on medical images. As discussed below, advancement of instrument 224 can additionally be automated, such as by surgeon 310 entering into human interface devices 145 a distance for tip 232 to be moved and a motorized version of measuring device 204 , such as described below, can be used to move instrument 224 .
- FIG. 11 is a schematic illustration showing an additional embodiment of the instrument holders described herein including multiple probes 220 A, 220 B and 220 C, including wheels 282 A, 282 B and 282 C, respectively.
- Probes 220 A, 220 B and 220 C can further include sensors, such as sensor 296 , though not illustrated for simplicity.
- Multiple probes can be included in instrument holder 200 to provide redundancy.
- multiple probes can facilitate centering of instrument 224 on axis 208 , such as by eliminating potential for a single probe to push instrument 224 off alignment with axis 208 .
- FIG. 11 illustrates multiple probes of the same type, i.e., each including a wheel for direct mechanical engagement of instrument 224 .
- any of the probes or measuring devices described herein can be combined in various combination to provide redundancy and stabilization to instrument 224 .
- FIG. 12 is a schematic illustration of mechanical position measuring device 320 for use with compatible instruments via engagement of a rack and pinion engagement system.
- Measuring device 320 can comprise motor 321 and encoder 322 , as well as wheel 282 B and axle 284 B.
- the rack and pinion engagement system can include rack gear teeth 324 located on instrument 224 B and pinion gear teeth 326 located on wheel 282 B.
- Wheel 282 B and axle 284 B can be configured to operate within a probe similar to operation of wheel 282 and axle 284 in probe 220 . As such, wheel 282 B can be configured to rotate about an axis perpendicular to axis 208 .
- Instrument 224 B can be pushed down into passage 226 to mechanically engage wheel 282 B.
- Passage 226 can include a cut-out or channel to accommodate teeth 324 .
- Teeth 324 can engage teeth 326 of wheel 282 B to become enmeshed. As such, rather than a frictional engagement, direct pushing of wheel 282 B can occur via pushing of teeth 324 against teeth 326 .
- Encoder 322 can be included in wheel 282 B or axle 284 B to record the rotational movement of wheel 282 B. Such rotational movement can be correlated to the linear translation of instrument 224 B to determine the position of the tip of instrument 224 B, as is described herein.
- Encoder 232 can comprise an electro-mechanical rotary encoder device where the angular position or motion of axle 284 is converted to analog or digital output signals. An encoder, such as encoder 232 , can additionally be provided within wheel 282 of FIGS. 3 and 6-8 to provide redundancy with sensor 296 or as an alternative to sensor 296 .
- wheel 282 B can be driven by motor 320 .
- Motor 320 can be used to move instrument 224 B automatically without intervention from surgeon 310 .
- a button or switch on control device 222 or human interface devices 145 can be actuated by surgeon 310 to activate movement of motor 320 and cause linear movement of instrument 224 B.
- Motor 320 can additionally be included in the other examples of instrument holders and measuring devices described herein.
- FIG. 13 is a flowchart illustrating actions or steps of methods or technique 500 for assembling instrument holder 200 with measuring device 204 and robotic surgical system 100 , calibrating measuring device 204 with calibration module 216 and using instrument holder 200 with measuring device 204 .
- instrument holder 200 can be assembled with robotic arm 120 .
- guide body 202 can be attached to extension 210 using fastener 304 .
- a position sensor can be attached to instrument holder 200 .
- measuring device 204 can be attached to guide body 202 by positioning mounting flange 242 in slot 278 on attachment body 218 .
- Measuring device 204 can be secured by inserting fastener 217 A into bore 276 A, through bore 244 A and into bore 217 B.
- calibration module 216 can be attached to instrument holder 200 .
- calibration module 216 can be attached to guide body 202 by positioning mounting flange 242 in slot 266 on coupling portion 260 .
- Calibration module 216 can be secured by inserting fastener 217 B into bore 268 and bore 244 B.
- instrument adapter 214 can be attached to instrument holder 200 .
- adapter tube 248 can be inserted into passage 206 within guide tube 240 .
- Instrument adapter 214 can be positioned so that stop flange 250 contacts top surface 246 .
- instrument 224 can be inserted into passage 226 of instrument adapter 214 .
- Instrument 224 can be positioned so that tip 232 remains within passage 226 above probe 220 for calibration and later deployment toward patient 312 .
- instrument 224 can be advanced within passage 226 until instrument contacts wheel 282 of probe 220 .
- instrument 224 can be advanced within passage 226 so that tip 232 engages and then moves past wheel 282 of probe 220 .
- Shaft 254 of instrument 224 can remain in contact with wheel 282 .
- movement of shaft 254 against wheel 282 can cause rotation of wheel 282 about axle 284 via frictional engagement.
- steps 502 - 512 can describe a method of assembling instrument holder 200 to robotic arm 120 , including a sub-method of assembling measuring device 204 , calibration module 216 and instrument adapter 214 to instrument holder 200 .
- instrument 224 can be advanced within passage 226 so that tip 232 contacts calibration module 216 .
- shaft 254 can be advanced until tip 232 contacts plate 262 .
- the position of instrument 224 relative to instrument holder 200 can be zeroed.
- a user of system 100 can press a button or activate a switch on control device 222 or human interface devices 145 .
- the position of instrument 224 and tip 232 can be recorded in surgical system 100 for referencing in the coordinate system of robotic arm 120 .
- Calibration module 216 can be removed from instrument holder 200 at step 516 .
- steps 512 - 516 can describe a method of calibrating measuring device 204 .
- robotic arm 120 can be positioned relative to patient 312 to position instrument holder 200 at a desired trajectory toward patient 312 .
- robotic arm 120 can be positioned before other steps of the method, such as before steps 506 and 508 where calibration module 216 and instrument adapter 214 are coupled to instrument holder 200 .
- instrument 224 can be translated within passage 226 along axis 208 toward patient 312 . Translation of instrument 224 can cause movement of tip 232 beyond the position of engagement with plate 262 when plate 262 was attached. Wheel 282 can rotate an amount corresponding to the movement of instrument 224 .
- the linear translation of instrument 224 can correspond to an arc length about the circumference of wheel 282 .
- a measurement of wheel 282 can be obtained using sensor 296 .
- Sensor 296 can correlate the circumferential rotation of wheel 282 to the linear distance that instrument 224 has traversed to determine a position of tip 232 relative to the zeroed position. Such position can be correlated back to the coordinate system of surgical system 100 via the known position of robotic arm 120 in the coordinate system.
- the mechanical measurement can alternatively, or additionally be taken, using an encoder, such as encoder 322 , to directly electro-mechanically measure the position of instrument 224 .
- a medical procedure or a step of a medical procedure can be performed with instrument 2224 held in a desired orientation, such as an orientation according to a medical plan.
- instrument 224 and instrument adapter 214 can be removed from instrument holder 200 . Subsequently, other surgical tasks can be performed by attaching a different instrument adapter to instrument holder 200 , calibrating the different instrument with measuring device 204 and calibration module 216 , and moving robotic arm 120 to a new position, such as by returning to step 506 or another step of method 500 .
- Steps 518 - 526 can describe a method of performing a medical procedure using instrument holder 200 and measuring device 204 to hold and track the position of instrument 224 .
- FIG. 14 illustrates system 600 for performing techniques described herein, in accordance with some embodiments.
- System 600 is an example of a system that can incorporate surgical system 100 of FIG. 1 .
- System 600 can include robotic surgical device 602 (e.g., robotic surgical device 115 ) coupled to instrument holder 604 (e.g., instrument holder 200 ), which may interact with tracking system 606 .
- the instrument holders described herein can be used without tracking system 606 .
- Tracking system 606 can include tracking element 608 and camera 610 .
- Instrument holder 604 can include measuring device 612 (e.g., measuring device 204 ).
- System 600 can include display device 614 , which can be used to display user interface 616 .
- System 600 can include control system 618 (e.g., a robotic controller or computing system 140 of FIG. 1 ), including processor 620 and memory 622 .
- display device 614 can be coupled to one or more of robotic surgical device 602 , tracking system 606 , or control system 618 .
- data generated by measuring device 612 can be shared with control system 618 , tracking system 606 and an operator of system 600 via display device 614 .
- measuring device 612 can be operated without input from tracking system 608 such that robotic surgical device 602 can be positioned and tracked by 1) movement of robotic arm 120 within the native coordinate system of robotic arm 120 and 2) movement of surgical device 602 relative to instrument holder 604 using measuring device 612 .
- FIG. 15 illustrates a block diagram of an example machine 1700 upon which any one or more of the techniques discussed herein may perform in accordance with some embodiments.
- machine 1700 can comprise computing system 140 of FIG. 1 .
- Machine 1700 can comprise an example of a controller for robotic system 115 and sensors 1721 can include the measuring devices described herein, such as measuring device 204 , and tracking elements 170 and 608 .
- instructions 1724 can be executed by processor 1702 to generate and correlate position information to determine the position of a surgical instrument relative to robotic arm 120 .
- position information of measuring device 204 e.g., sensor 1721
- relating to the location of tip 232 relative to guide body 202 can be stored in main memory 1704 and accessed by processor 1702 .
- Processor 1702 can also receive input (such as at input device 1712 ) relating to the position of instrument holder 200 relative to robotic arm 120 and store such information in main memory 1704 .
- Processor 1702 can further relate position information of tip 232 . to the position information of arm 120 to correlate the position of tip 232 to robotic arm 120 , not just instrument holder 200 .
- As tip 232 moves machine 1700 can continuously track and update the location of tip 232 relative to robotic arm 120 via measuring device 204 and, for example, display said position on display device 1710 (e.g., user interface devices 145 ).
- machine 1700 may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, machine 1700 may operate in the capacity of a server machine, a client machine, or both in server-client network environments. In an example, machine 1700 may act as a peer machine in peer-to-peer (P2P) (or other distributed) network environment.
- Machine 1700 may be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine.
- PC personal computer
- PDA personal digital assistant
- machine shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), other computer cluster configurations.
- cloud computing software as a service
- SaaS software as a service
- Machine (e.g., computer system) 1700 may include hardware processor 1702 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), main memory 1704 and static memory 1706 , some or all of which may communicate with each other via interlink (e.g., bus) 1708 .
- Machine 1700 may further include display unit 1710 , alphanumeric input device 1712 (e.g., a keyboard), and user interface (UI) navigation device 1714 (e.g., a mouse).
- display unit 1710 , input device 1712 and UI navigation device 1714 may be a touch screen display.
- Machine 1700 may additionally include storage device (e.g., drive unit) 1716 , signal generation device 1718 (e.g., a speaker), network interface device 1720 , and one or more sensors 1721 , such as a global positioning system (GPS) sensor, compass, accelerometer, or other sensor.
- Machine 1700 may include output controller 1728 , such as a serial (e.g., Universal Serial Bus (USB), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NEC), etc.) connection to communicate or control one or more peripheral devices (e.g., a printer, card reader, etc.).
- storage device e.g., drive unit
- signal generation device 1718 e.g., a speaker
- network interface device 1720 e.g., a global positioning system (GPS) sensor, compass, accelerometer, or other sensor.
- GPS global positioning system
- Machine 1700 may include output controller 1728 , such as a serial (e.
- Storage device 1716 may include machine readable medium 1722 on which is stored one or more sets of data structures or instructions 1724 (e.g., software) embodying or utilized by any one or more of the techniques or functions described herein. Instructions 1724 may also reside, completely or at least partially, within main memory 1704 , within static memory 1706 , or within hardware processor 1702 during execution thereof by machine 1700 . In an example, one or any combination of hardware processor 1702 , main memory 1704 , static memory 1706 , or storage device 1716 may constitute machine readable media.
- data structures or instructions 1724 e.g., software embodying or utilized by any one or more of the techniques or functions described herein. Instructions 1724 may also reside, completely or at least partially, within main memory 1704 , within static memory 1706 , or within hardware processor 1702 during execution thereof by machine 1700 . In an example, one or any combination of hardware processor 1702 , main memory 1704 , static memory 1706 , or storage device 1716 may constitute machine readable media.
- machine readable medium 1722 is illustrated as a single medium, the term “machine readable medium” may include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) configured to store the one or more instructions 1724 .
- the term “machine readable medium” may include any medium that is capable of storing, encoding, or carrying instructions for execution by machine 1700 and that cause machine 1700 to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions.
- Non-limiting machine readable medium examples may include solid-state memories, and optical and magnetic media.
- Instructions 1724 may further be transmitted or received over communications network 1726 using a transmission medium via network interface device 1720 utilizing any one of a number of transfer protocols (e.g., frame relay, internet protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.).
- transfer protocols e.g., frame relay, internet protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.
- Example communication networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), mobile telephone networks (e.g., cellular networks), Plain Old Telephone (POTS) networks, and wireless data networks (e.g., Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards known as Wi-Fi®, IEEE 802.16 family of standards known as WiMax®), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, among others.
- network interface device 1720 may include one or more physical jacks (e.g., Ethernet, coaxial, or phone jacks) or one or more antennas to connect to communications network 1726 .
- network interface device 1720 may include a plurality of antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) techniques.
- SIMO single-input multiple-output
- MIMO multiple-input multiple-output
- MISO multiple-input single-output
- transmission medium shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by machine 1700 , and includes digital or analog communications signals or other intangible medium to facilitate communication of such software.
- the systems, devices and methods discussed in the present application can be useful in performing robotic-assisted surgical procedures that utilize robotic surgical arms that can be coupled to instrument holders used to precisely align trajectories of instruments relative to anatomy of a patient registered to the space of an operating room.
- the present disclosure describes adjustable instrument holders that can remain mounted to a robotic surgical arm throughout a surgical procedure.
- the adjustable instrument holders can be adjusted to hold instruments of different sizes, e.g., different diameters, without removing the instrument holder form the robotic arm.
- the adjustable instrument holders can be easily and quickly manipulated to remove a first instrument of a first size and insert a second instrument of a second size, thereby decreasing time for performing a surgical procedure.
- the adjustable instrument holders can include passages that have variable orifice sizes, e.g., variable diameters, formed by adjustable members, such as jaws or blades, that form adjustable jaws, chucks or diaphragms to align an instrument and hold an instrument along a trajectory.
- adjustable instrument holders can include adjustment members that provide axial length along an axis of the trajectory to provide stability to the instrument.
- the adjustable instrument holders can additionally be easily and quickly assembled and disassembled for cleaning, sanitizing and sterilizing procedures.
- Example 1 can include or use subject matter such as an instrument holder system that can comprise a guide body comprising a first end, a second end, and a passage extending between the first and second ends along an axis to receive an instrument; and a mechanical or electro-mechanical measuring device comprising an attachment body for coupling to the guide body, and a probe configured to extend into a trajectory of the passage to contact the instrument and generate positional data.
- an instrument holder system can comprise a guide body comprising a first end, a second end, and a passage extending between the first and second ends along an axis to receive an instrument; and a mechanical or electro-mechanical measuring device comprising an attachment body for coupling to the guide body, and a probe configured to extend into a trajectory of the passage to contact the instrument and generate positional data.
- Example 2 can include, or can optionally be combined with the subject matter of Example 1, to optionally include a probe comprising a wheel configured to rotate about an axle.
- Example 3 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 or 2 to optionally include a probe further comprising a reader device configured to determine a rotational position of the wheel about the axle.
- Example 4 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 3 to optionally include a reader device comprising a laser, and a wheel comprising marks configured to be read by the laser.
- Example 5 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 4 to optionally include a reader device comprising an encoder embedded into the wheel or axle.
- Example 6 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 5 to optionally include a sliding bracket coupled to the wheel, the sliding bracket being adjustable relative to the axis, and a biasing member configured to push the sliding bracket toward the axis.
- Example 7 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 6 to optionally include a probe that further comprises a plurality of wheels each having an instrument contact surface, the instrument contact surfaces configured to surround the axis.
- Example 8 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 7 to optionally include a wheel having teeth.
- Example 9 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 8 to optionally include a motor configured to rotate the wheel.
- Example 10 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 9 to optionally include a control device coupled to the probe and configured to receive the positional data.
- Example 11 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 10 to optionally include a control device that comprises a transmitter configured to transmit the positional data via a signal to a surgical system.
- Example 12 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 11 to optionally include a transmitter that comprises a wireless signal transmitter.
- Example 13 can include, or can optionally be combined with the subject matter of Example 12, to optionally include a guide body further comprising an instrument adapter configured to adjust a size of the passage.
- Example 14 can include, or can optionally be combined with the subject matter of Example 13, to optionally include a calibration module comprising a first portion configured to couple to the second end of the guide body, and a plate extending from the first portion to oppose the second end of the guide body, wherein the plate is located a fixed distance from the second end of the guide body, a magnitude of the fixed distance being electronically stored in the control device.
- a calibration module comprising a first portion configured to couple to the second end of the guide body, and a plate extending from the first portion to oppose the second end of the guide body, wherein the plate is located a fixed distance from the second end of the guide body, a magnitude of the fixed distance being electronically stored in the control device.
- Example 15 can include or use subject matter such as a method of determining a position of a surgical instrument relative to an instrument holder for a robotic arm comprising inserting an instrument into a passage of the instrument holder, moving the instrument into contact with a sensing element mounted to the instrument holder, moving a tip of the instrument out of the instrument holder to cause movement of the sensing element, and correlating movements of the sensing element to distances the tip extends out of the instrument holder.
- Example 16 can include, or can optionally be combined with the subject matter of Example 15 to optionally include moving a tip of the instrument out of the instrument holder to cause movement of the sensing element by causing rotation of the sensing element.
- Example 17 can include, or can optionally be combined with the subject matter of one or any Examples 15 and 16 to optionally include biasing the sensing element toward an axial center of the passage.
- Example 18 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 17 to optionally include moving the instrument into contact with the sensing element by moving the instrument into frictional engagement with the sensing element or moving the instrument into meshed engagement with the sensing element.
- Example 19 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 18 to optionally include calibrating a zero position for the tip of the instrument relative to the instrument holder.
- Example 20 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 19 to optionally include calibrating the zero position for the tip by engaging the tip with a plate of a calibration module disposed opposite an outlet of the instrument holder.
- Example 21 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 20 to optionally include correlating movements of the sensing element to distances the tip extends out of the instrument holder by reading rotation of the sensing element with a reader configured to identify hash marks on the sensing element.
- Example 22 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 21 to optionally include correlating movements of the sensing element to distances the tip extends out of the instrument holder comprises reading rotation of a shaft of the sensing element with an encoder.
- Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples.
- An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, in an example, the code can be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or at other times.
- Examples of these tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMS), read only memories (ROMs), and the like.
Abstract
Description
- This application claims the benefit of U.S. Provisional Patent Application Serial No. 62/923,107, filed on Oct. 18, 2019, the benefit of priority of which is claimed hereby, and which is incorporated by reference herein in its entirety.
- This document pertains generally, but not by way of limitation, to devices and methods for robot-assisted surgical procedures, such those involving the use of articulating robotic arms that can be moved about multiple axes. More specifically, but not by way of limitation, the present application relates to holders and guides that can be used to position instruments relative to a robotic arm.
- Imaging of anatomical features can be useful in preparing for and performing surgical procedures. In some surgical procedures it can be desirable to register the shape of the anatomy in the obtained images with another frame of reference, such as the physical space of an operating room. The physical space of the operating room can be correlated to a frame of reference for a robotic surgical system. Robotic surgical arms are used to hold various instruments in place in a desired orientation relative to both the anatomy and operating room during a procedure so that movement of an instrument in the operating room relative to the anatomy can be tracked on the anatomic imaging based on movement of the robotic surgical arm. It is, therefore, desirable to precisely mount instruments to the robotic surgical arm. Means for measuring a position of an instrument relative to an instrument holder are described in Pub. No. WO 2015/061638 A1 to Crawford et al.
- The present inventors have recognized, among other things, that problems to be solved with traditional robotic instrument holders can include knowing the relative position of an instrument within an instrument holder relative to a robotic arm holding the instrument. During surgeries involving a robotic surgical system, it can be desirable to precisely guide a medical instrument along a planned trajectory based on medical images. In order to maintain the trajectory of the instrument, surgeons use guide tubes or other devices that are mounted to a robotic surgical arm. Once the instrument is aligned along the desired trajectory, the robotic arm becomes immobilized and the instrument is moved along the trajectory through the instrument holder. Since the robot arm is not moving and the instrument is not attached on it, the precise position of the instrument cannot be determined via the location of the robotic arm. Previous attempts to determine the position of the instrument include attaching a tracking device to the instrument that can be tracked in a coordinate system synched to the coordinate system of the robotic arm. However, optical navigation systems require line-of-sight with the instrument to be maintained in order to obtain accurate position information. Other attempts to determine position of an instrument relative to the instrument holder involve using sensors in the instrument holder that read information off the instrument, as are described in the aforementioned publication to Crawford et al. Such systems, however, require the use instruments that are compatible with the sensor. As such, the instrument typically must include appropriate visual indicia (e.g., coated markers such as contrast or color marks or gradients) for optical reading or include metallic indicia (e.g., embedded magnetic strips or coils) for magnetic reading. Thus, such systems are not compatible with a wide variety of conventional instruments or off-the-shelf instruments, which can increase the cost and complexity of the instruments.
- The present subject matter can provide a solution to these and other problems, such as by providing an instrument holder having a measuring device that can determine position information of conventional instruments and non-conventional instruments (e.g., those including visual or magnetic indicia). More particularly, the present subject matter can provide an instrument holder that includes a mechanical or electro-mechanical device for determining position of the instrument independent of features of the instrument in order to accommodate off-the-shelf and conventional (e.g., non-marked) instrumentation.
- The present subject matter relates to medical instrument holder devices, such as for robotic surgical systems, that have mechanical or electro-mechanical position readers or sensors that can physically contact or engage the instrument while the instrument is inserted in or proximate to the position holder. Thus, in examples, the medical instrument holder devices of the present disclosure facilitate reading position information from any type of instrument without requiring special instruments compatible with the mechanical or electro-mechanical position reader. The position readers allow for precise alignment of the instrument relative to the position holder, thereby allowing the depth that a tip of an instrument is extended beyond the instrument holder, e.g., into a patient to be known and correlated to a coordinate system of the robotic surgical system,
- In an example, an instrument holder system can comprise a guide body and a mechanical or electro-mechanical measuring device. The guide body can comprise a first end, a second end, and a passage extending between the first and second ends along an axis to receive an instrument. The measuring device can comprise an attachment body for coupling to the guide body, a probe configured to extend into a trajectory of the passage to contact the instrument and generate positional data and, optionally, a control device coupled to the probe and configured to receive the positional data.
- In another example, a method of determining a position of a surgical instrument relative to an instrument holder for a robotic surgical system can comprise inserting the surgical instrument into a passage of the instrument holder, moving the instrument into contact with a sensing element, moving a tip of the instrument out of the instrument holder to cause movement of the sensing element, and correlating movements of the sensing element to distances the tip extends out of the instrument holder.
- This overview is intended to provide an overview of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the present patent application.
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FIG. 1 is a diagrammatic view of an operating room including a robot-assisted surgical system comprising a robotic arm, a computing system and a tracking system. -
FIG. 2 is a schematic view of the robotic arm ofFIG. 1 including an instrument holder configured to support or guide an instrument along an axis with a depth control device. -
FIG. 3 is a perspective view of an instrument holder having a depth control device for aligning and holding in-place various medical instruments during surgeries performed with a surgical robot, such as the robot-assisted surgical system ofFIGS. 1 and 2 . -
FIG. 4 is a perspective exploded view of a guide body, instrument adapter and an instrument of the instrument holder ofFIG. 3 . -
FIG. 5 is a perspective view of a calibration module of the instrument holder ofFIG. 3 . -
FIG. 6 is a perspective exploded view of a measuring device of the instrument holder ofFIG. 3 . -
FIG. 7 is a side view of the instrument holder ofFIG. 3 attached to the robotic arm ofFIGS. 1 and 2 and showing the instrument inserted through the guide body to engage the calibration module. -
FIG. 8 is a side cross-sectional view of the instrument holder ofFIG. 7 with the calibration module removed. -
FIG. 9 is a schematic illustration showing the depth control device of the instrument holder ofFIG. 3 being calibrated in an operating room environment. -
FIG. 10 is a schematic illustration showing the depth control device of the instrument holder ofFIG. 3 being used to guide an instrument into engagement with a patient in the operating room environment. -
FIG. 11 is a schematic illustration showing an additional embodiment of the instrument holder described herein including multiple measuring devices. -
FIG. 12 is a schematic illustration of a position measuring device for use with compatible instruments via engagement of a rack and pinion engagement system. -
FIG. 13 is a flow chart illustrating steps of methods for assembling an instrument holder with a measuring device and a robotic surgical system, calibrating the measuring device of the instrument holder and using the instrument holder with the measuring device. -
FIG. 14 is a schematic illustration of a robotic surgical system incorporating an instrument holder having a depth control device of the present application interacting with a tracking system. -
FIG. 15 is a schematic illustration of a block diagram of an example machine upon which any one or more of the techniques discussed herein may perform and with which any of the devices discussed herein may be used in accordance with some embodiments. - In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.
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FIG. 1 illustratessurgical system 100 for operation onsurgical area 105 ofpatient 110 in accordance with at least one example of the present disclosure.Surgical area 105 in one example can include a joint and, in another example, can be a bone.Surgical area 105 can include any surgical area ofpatient 110, including but not limited to the shoulder, head, elbow, thumb, spine, and the like.Surgical system 100 can also includerobotic system 115 with one or more robotic arms, such asrobotic arm 120. As illustrated,robotic system 115 can utilize only a single robotic arm.Robotic arm 120 can be a 6 degree-of-freedom (DOF) robot arm, such as the ROSA® robot from Medtech, a Zimmer Biomet Holdings, Inc. company, In some examples,robotic arm 120 is cooperatively controlled with surgeon input on the end effector or surgical instrument, such assurgical instrument 125. In other examples,robotic arm 120 can operate autonomously. While not illustrated inFIG. 1 , one or more positionable surgical support arms can be incorporated intosurgical system 100 to assist in positioning and stabilizing instruments or anatomy during various procedures. - Each
robotic arm 120 can rotate axially and radially can receive a surgical instrument, or end effector, 125 atdistal end 130.Surgical instrument 125 can be any surgical instrument adapted for use by therobotic system 115, including, for example, a guide tube, a holder device, a gripping device such as a pincer grip, a burring device, a reaming device, an impactor device such as a humeral head impactor, a pointer, a probe or the like.Surgical instrument 125 can be positionable byrobotic arm 120, which can include multiple robotic joints, such asjoints 135, that allowsurgical instrument 125 to be positioned at any desired location adjacent or within a givensurgical area 105. As discussed below,robotic arm 120 can be used with an instrument positioning device, e.g., instrument holder 200 (FIG. 2 ), to position an instrument in a known, desired or predetermined orientation relative tosurgical area 105 based on a virtual coordinate system determined by computingsystem 140. -
Robotic system 115 can also includecomputing system 140 that can operaterobotic arm 120 andsurgical instrument 125.Computing system 140 can include at least memory, a processing unit, and user input devices, as will be described herein.Computing system 140 andtracking system 165 can also includehuman interface devices 145 for providing images for a surgeon to be used during surgery.Computing system 140 is illustrated as a separate standalone system, but in someexamples computing system 140 can be integrated intorobotic system 115.Human interface devices 145 can provide images, including but not limited to three-dimensional images of bones, glenoid, joints, and the like.Human interface devices 145 can include associated input mechanisms, such as a touch screen, foot pedals, or other input devices compatible with a surgical environment. -
Computing system 140 can receive pre-operative, intra-operative and post-operative medical images. These images can be received in any manner and the images can include, but are not limited to, computed tomography (CT) scans, magnetic resonance imaging (MRI), two-dimensional x-rays, three-dimensional x-rays, ultrasound, and the like. These images in one example can be sent via a server as files attached to an email. In another example the images can be stored on an external memory device such as a memory stick and coupled to a USB port of the robotic system to be uploaded into the processing unit. In yet other examples, the images can be accessed over a network by computingsystem 140 from a remote storage device or service. - After receiving one or more images,
computing system 140 can generate one or more virtual models related tosurgical area 105. Alternatively,computer system 140 can receive virtual models of the anatomy of the patient prepared remotely. Specifically, a virtual model of the anatomy ofpatient 110 can be created by defining anatomical points within the image(s) and/or by fitting a statistical anatomical model to the image data. The virtual model, along with virtual representations of implants, can be used for calculations related to the desired height, depth, inclination angle, or version angle of an implant, stem, surgical instrument, or the like related to be utilized insurgical area 105. In another procedure type, the virtual model can be utilized to determine insertion location, trajectory and depth for inserting an instrument. The virtual model can also be used to determine bone dimensions, implant dimensions, bone fragment dimensions, bone fragment arrangements, and the like. Any model generated, including three-dimensional models, can be displayed onhuman interface devices 145 for reference during a surgery or used byrobotic system 115 to determine motions, actions, and operations ofrobotic arm 120 orsurgical instrument 125. Known techniques for creating virtual bone models can be utilized, such as those discussed in U.S. Pat. No. 9,675,461, titled “Deformable articulating templates” or U.S. Pat. No. 8,884,618, titled “Method of generating a patient-specific bone shell” both by Mohamed Rashwan Mahfouz, as well as other techniques known in the art. -
Computing system 140 can also communicate withtracking system 165 that can be operated by computingsystem 140 as a stand-alone unit.Surgical system 100 can utilize the Polaris optical tracking system from Northern Digital, Inc. of Waterloo, Ontario, Canada. Additionally,tracking system 165 can comprise the tracking system shown and described in Pub. No. US 2017/0312035, titled “Surgical System Having Assisted Navigation” to Brian M. May, which is hereby incorporated by this reference in its entirety.Tracking system 165 can monitor a plurality of tracking elements; such as trackingelements 170 ; affixed to objects of interest to track locations of multiple objects within the surgical field.Tracking system 165 functions to create a virtual three-dimensional coordinate system within the surgical field for tracking patient anatomy, surgical instruments, or portions ofrobotic system 115.Tracking elements 170 can be tracking frames including multiple IR reflective tracking spheres, or similar optically tracked marker devices. In one example, trackingelements 170 can be placed on or adjacent one or more bones ofpatient 110. In other examples, trackingelements 170 can be placed on robotrobotic arm 120,surgical instrument 125, and/or an implant to accurately track positions within the virtual coordinate system associated withsurgical system 100. In eachinstance tracking elements 170 can provide position data, such as patient position, bone position, joint position, robotic arm position, implant position, or the like. -
Robotic system 115 can include various additional sensors and guide devices. For example,robotic system 115 can include one or more force sensors, such as force sensor 180. Force sensor 180 can provide additional force data or information tocomputing system 140 ofrobotic system 115. Force sensor 180 can be used by a surgeon to cooperatively moverobotic arm 120. For example, force sensor 180 can be used to monitor impact or implantation forces during certain operations, such as insertion of an implant stem into a humeral canal. Monitoring forces can assist in preventing negative outcomes through force fitting components. In other examples, force sensor 180 can provide information on soft-tissue tension in the tissues surrounding a target joint. In certain examples,robotic system 115 can also includelaser pointer 185 that can generate a laser beam or array that is used for alignment of implants during surgical procedures. - In order to ensure that
computing system 140 is movingrobotic arm 120 in a known and fixed relationship tosurgical area 105 andpatient 110, the space ofsurgical area 105 andpatient 110 can be registered tocomputing system 140 via a registration process involving registering fiducial markers attached topatient 110 with corresponding images of the markers inpatient 110 recorded preoperatively or just prior to a surgical procedure. For example, a plurality of fiducial markers can be attached topatient 110, images ofpatient 110 with the fiducial markers can be taken or obtained and stored within a memory device ofcomputing system 140. Subsequently,patient 110 with the fiducial markers can be moved into, if not already there because of the imaging,surgical area 105 androbotic arm 120 can touch each of the fiducial markers. Engagement of each of the fiducial markers can be cross-referenced with, or registered to, the location of the same fiducial marker in the images. In additional examples,patient 110 and medical images of the patient can be registered in real space using contactless methods, such as by using a laser rangefinder held byrobotic arm 120 and a surface matching algorithm that can match the surface of the patient from scanning of the laser rangefinder and the surface of the patient in the medical images. As such, the real-world, three-dimensional geometry of the anatomy attached to the fiducial markers can be correlated to the anatomy in the images and movements ofinstruments 125 attached torobotic arm 120 based on the images will correspondingly occur insurgical area 105. - Subsequently, other instruments and devices attached to
surgical system 100 can be positioned byrobotic arm 120 into a known and desired orientation relative to the anatomy. For example,robotic arm 120 can be coupled to an instrument holder including a depth control device of the present disclosure.Robotic arm 120 can move the instrument holder and depth control device into different positions relative to anatomy of the patient such that an axis of the adjustable instrument holder extends along a desired orientation relative to the anatomy. The depth control devices of the present application can enablesurgical system 100 to know the location of an instrument relative to the instrument holder so that the precise position of the instrument relative torobotic arm 120 can be determined, without the use of an optical tracking system of manual efforts. -
FIG. 2 is a schematic view ofrobotic arm 120 ofFIG. 1 includinginstrument holder 200, can be positioned byrobotic arm 120 relative to surgical area 105 (FIG, 1) in a known orientation.Instrument holder 200 can compriseguide body 202 and measuringdevice 204.Passage 206 can extend throughguide body 202 and measuringdevice 204 alongaxis 208.Instrument holder 200 can be coupled torobotic arm 120 viaextension 210 and mountingplate 212. -
Robotic arm 120 can include joint 135A that permits rotation aboutaxis 216A, joint 135B that can permit rotation aboutaxis 216B, joint 135C that can permit rotation aboutaxis 216C and joint 135D that can permit rotation aboutaxis 216D. - In order to position
instrument holder 200 relative to anatomy of patient 110 (FIG. 1 ), surgical system 100 (FIG. 1 ) can manipulaterobotic arm 120 automatically by computingsystem 140 or a surgeon manually operatingcomputing system 140 to moveinstrument holder 200 to the desired location, e.g., a location called for by a surgical plan to align an instrument relative to the anatomy. For example,robotic arm 120 can be manipulated alongaxes 216A-216D to positionpassage 208 ofinstrument holder 200 along a trajectory for which an instrument is to be guided. -
Robotic arm 120 can be separately registered to the coordinate system ofsurgical system 100, such via use of atracking element 170. Fiducial markers can additionally be separately registered to the coordinate system ofsurgical system 100 via engagement with a probe having atracking element 170 attached thereto. As such, some or all of the components ofsurgical system 100 can be individually registered to the coordinate system and, if desired, movement of such components can be continuously or intermittently tracked with atracking element 170. - It can be a difficult task to ensure instruments attached to
robotic arm 120 are accurately aligned with and positioned relative topatient 110, particularly if the instrument needs to be individually manipulated during the procedure, such as by intervention of personnel including a surgeon. For example, sometimesrobotic arm 120 is positioned to provide the proper alignment of an instrument, e.g., a guide pin, that needs to be inserted into the patient. Thus,robotic arm 120 can automatically provide a trajectory for an instrument, while the surgeon manually provides the motive force for the instrument. However, once the surgeon moves the instrument relative torobotic arm 120, the precise location of the instrument, e.g., the location of the tip of the instrument in the coordinate system, can become lost or obfuscated, andsurgical system 100 will not be able to reproduce the location of said tip in imaging of the patient. - In some robotic procedures instruments can be separately tracked using an optical navigation system that, under ideal conditions, alleviate the need for precisely maintaining
axis 208 and the location of an instrument alongaxis 208 through a surgical procedure or surgical task, as the optical navigation system can provide the surgical computer system information to compensate for any changes. However, as optical navigation systems require line-of-sight with the instruments to be maintained, there is a significant advantage in not requiring instruments to be navigated (or at least not constantly navigated). Accordingly, the ability to precisely maintainaxis 208 and position alongaxis 208 provides the additional advantage of at least reducing, and possibly eliminating, the need to navigate instruments during a robotic procedure. - In order to improve the ability to determine the location of instruments within the coordinate system, such as along
axis 208, the present application describes various measuring devices (e.g., depth control devices, sensing devices, mechanical position determining devices, electro-mechanical positioning devices) that can determine the position of an instrument relative to an instrument holder without requiring line-of-sight or specialty instruments, such that the position of the instrument relative torobotic arm 120 and the coordinate system can be determined. -
FIG. 3 is a perspective view ofinstrument holder 200 comprisingguide body 202 and measuringdevice 204. Passage 206 (FIG. 2 ) can extend throughguide body 202 and measuringdevice 204 alongaxis 208.Instrument holder 200 can be coupled torobotic arm 120 viaextension 210 and mountingplate 212.Instrument holder 200 can further compriseinstrument adapter 214 andcalibration module 216. Measuringdevice 204 andcalibration module 216 can be affixed to guidebody 202 viafasteners device 204 can compriseattachment body 218,probe 220 andcontrol device 222.Instrument holder 200 can be used in conjunction withinstrument 224.Instrument holder 200 andinstrument adapter 214 can comprise devices for holding an instrument, such as medical instruments including catheters, cannulas and guidewires. -
Instrument adapter 214 can be configured to be inserted into passage 206 (FIG. 2 ) ofguide body 202.Instrument adapter 214 can includepassage 226 for receivinginstrument 224.Passage 226 ininstrument adapter 214 can be positioned to align with axis 208 (FIG. 2 ) such thatpassage 226 andpassage 206 are concentric.Robotic arm 120 can be configured to positionguide body 202 and henceinstrument adapter 214 in a fixed orientation such thataxis 208 is aligned relative to a patient in a desired orientation, such as an orientation pre-operatively or intra-operatively planned according to a surgical plan. - Mounting
plate 212 can be mounted to robotic arm 120 (FIG. 2 ) such as by inserting threaded fasteners intobores 228.Extension 210 can be coupled to mountingplate 212 to provide a mounting arm for coupling withinstrument holder 200.Extension 210 can includeseat 230 having a semi-circular or circular arc length shape to receive and mate withguide body 202.Extension 210 and guidebody 202 can be coupled using any suitable means, such as fasteners (e.g.,fastener 304 ofFIG. 8 ) or metallurgical bonding.Extension 210 can extend along an axis that is perpendicular toaxis 208.Extension 210 can be configured to alignpassage 206 extending throughguide body 202 at a known position relative tobores 228 such that the position ofpassage 206 torobotic arm 120 is in a known, e.g., known tocomputing system 140, orientation. Thus, asrobotic arm 120 movesinstrument holder 200, the position ofinstrument holder 200 relative to surgical area 105 (FIG. 1 ) will also be known. - After
instrument holder 200 is attached to robotic arm (FIG. 2 .) via mountingplate 212,instrument adapter 214,calibration module 216 and measuringdevice 204 can be attached to guidebody 202.Instrument adapter 214,calibration module 216 and measuringdevice 204 can be assembled tomain body 202 in any order.Instrument adapter 214,calibration module 216 and measuringdevice 204 can be used to determine the relative position ofinstrument 224 toinstrument holder 200, such as how far atip 232 ofinstrument 224 extends beyond an inferior end, e.g.,bottom surface 234, ofmain body 202. -
FIG. 4 is a perspective exploded view ofguide body 202,instrument adapter 214 andinstrument 224 ofinstrument holder 200 ofFIG. 3 .Guide body 202 can compriseguide tube 240, mountingflange 242, bores 244A and 244B,top surface 246 andbottom surface 234.Guide tube 240 can definepassage 206.Instrument adapter 214 can compriseadapter tube 248, stopflange 250,top surface 252 andpassage 226.Instrument 224 can compriseshaft 254,flange 256 andtip 232. -
Adapter tube 248 can have an outer diameter sized to closely mate with the inner diameter ofpassage 206.Passage 226 can be centered withinadapter tube 248. As such,passage 226 can be positioned concentric withpassage 206 via placement ofadapter tube 248 withinguide tube 240. Stopflange 250 can have a diameter larger than that ofpassage 206, and guidetube 240, to preventadapter tube 248 from passing completely throughguide tube 240. As such, stop flange 250 can rest on a superior end, e.g.,top surface 246, ofguide tube 240. In examples,adapter tube 248 can be friction-fit intoguide tube 240.Adapter tube 248 can be approximately equal in length to guidetube 240. However, as shown inFIG. 8 ,adapter tube 248 can be shorter thanguide tube 240 to, for example, not interfere withtip 232 extending belowbottom surface 234. -
Shaft 254 can have an outer diameter sized to closely mate with the inner diameter ofpassage 226. As such,shaft 254 can be centered withinpassage 226 andinstrument 224 can be centered withininstrument holder 200.Shaft 254 can be longer than the length ofguide tube 240 to allowtip 232 to extend out of, e.g., beyondbottom surface 234,guide tube 240. Stopflange 256 can have a diameter larger than that ofshaft 254 andpassage 226 to preventinstrument 224 from passing completely throughinstrument adapter 214. As such, stop flange 256 can rest on a superior end, e.g.,top surface 252, ofinstrument adapter 214. In examples,shaft 254 can be friction-fit intopassage 226 such thatinstrument 224 can remain in place within instrument adapter withoutshaft 254 freely sliding intopassage 226. As such,instrument 224 can be held in-place withininstrument adapter 214 in a desired position. For example,tip 232 can be held by frictional engagement betweenshaft 254 andadapter tube 248inside passage 226 until a surgeon is ready to advancetip 232 toward a patient, such as by manually pushing onflange 256. - Mounting
flange 242 can extend frombottom surface 234 ofguide tube 240 and, as such, can have an outer diameter larger thanguide tube 240.Flange 242 can provide a platform for mounting other components to guidebody 202.Flange 242 can extend completely around the perimeter ofguide tube 240 to allow attachment at any location around the circumference ofguide tube 240. However, mountingflange 242 can includebores flange 242, e.g. one-hundred-eighty degrees apart, to receivecalibration module 216 and measuringdevice 204. -
FIG. 5 is a perspective view ofcalibration module 216 ofinstrument holder 200 ofFIG. 3 .Calibration module 216 can comprisecoupling portion 260,plate 262 andextension 264. Couplingportion 260 can compriseslot 266 and bore 268. Bore 268 can comprise upper and lower portions extending through opposite sides ofslot 266. Couplingportion 260 can comprise a flange configured to mate with mounting flange 242 (FIG. 4 ) ofguide body 202. Slot 266 can have a height sufficient to receive mountingflange 242 and that is sufficiently deep to allow one ofbores bore 268. As such, one offasteners FIG. 3 ) can be extended through one ofbores calibration module 216 to guidebody 202.Slot 266 andplate 262 can extend in parallel planes.Plate 262 can have a length sufficient to extend fromextension 264 to axis 208 (FIGS. 2 and 3 ) such thatplate 262 can opposepassage 226. Thus,plate 262 can be configured to engage any diameter of instrument that extends frompassage 206, for different sizes ofpassage 226 ofinstrument adapter 214.Extension 264 can extend away from couplingportion 260 to space plate 262 a distance away fromslot 266. The distance thatplate 262 is positioned away fromslot 266 can be a fixed distance that is predetermined and known, e.g., known to computing system 140 (e.g., stored in memory of computing system 140). As will be discussed below,plate 262 can be used to zero the position ofinstrument 224 relative to guidebody 202. -
FIG. 6 is a perspective exploded view of measuringdevice 204 ofinstrument holder 200FIG. 3 . Measuringdevice 204 can comprise a sensing device or depth control device configured to determine or sense the position ofinstrument 224 relative to guidebody 202, which can be used to control the distance thatinstrument 224 is extended fromguide body 202, e.g. the depth that instrument is inserted into a patient. Measuringdevice 204 can compriseattachment body 218,probe 220 andcontrol device 222.Attachment body 218 can comprisecoupling portion 270,sensor bracket 272, and mountingposts portion 270 can comprisebores slot 278.Sensor bracket 272 can comprise bore 280. Probe 220 can comprisewheel 282,axle 284, mountingbrackets posts Control device 222 can comprisehousing 292,tube 294 andsensor 296.Wheel 282 can include hash marks 298. - Coupling
portion 270 can comprise a flange configured to mate with mounting flange 242 (FIG. 4 ) ofguide body 202. Slot 278 can have a height sufficient to receive mountingflange 242 and that is sufficiently deep to allow one ofbores bores fasteners FIG. 3 ) can be extended through one ofbores device 204 to guidebody 202. -
Sensor bracket 272 can extend fromcoupling portion 270 to position bore 280 and mountingposts instrument 224 when extended out ofpassage 226 beyond bottom surface 234 (FIG. 3 ), e.g., to opposeextension 264 when both measuringdevice 204 andcalibration module 216 are attached to mountingflange 242. Bore 280 can be configured to receivetube 294 ofcontrol device 222. As such,control device 222 can be mounted to an exterior surface ofsensor bracket 272 such thattube 294 extends past an interior surface ofsensor bracket 272 toward axis 208 (FIG. 3 ).Tube 294 can be threaded intobore 280 or can be held in place by fasteners, e.g., nuts, threaded ontotube 294.Sensor 296 can be located intube 294 orhousing 292 and can be configured to sense or emit signal S (FIG. 7 ) out oftube 294 towardaxis 208. Housing 292 can comprise an enclosure or container to provide support and protection for components ofcontrol device 222. In addition tosensor 296,power module 300 and transmitter 302 (FIG. 8 ) can be stored inhousing 292 and electrically coupled tosensor 296. - Probe 220 can comprise any suitable device for mechanically engaging
instrument 224 and providing feedback to controldevice 222. In examples, probe 220 can be configured to make physical contact withinstrument 224. In the illustrated example, probe 220 can comprisewheel 282 rotatable about or onaxle 284. Thus,wheel 282 can be configured to rotate about an axis perpendicular toaxis 208. Mountingbrackets wheel 282 via engagement withaxle 284. Mountingbrackets posts Springs posts Springs posts posts posts springs Posts posts wheel 282 to be displaceable relative toaxis 208.Springs bias wheel 282 towardaxis 208.Springs posts posts wheel 282 to traverse anywhere between contact ofwheel 282 withaxis 208 to a distance away fromaxis 208 to accommodate the largest sized instrument positionable withinguide tube 240. In other words,wheel 282 can have a stroke length equal to, or greater than, the radius ofguide tube 240.Springs posts posts -
FIG. 7 is a side view ofinstrument holder 200 ofFIG. 3 attached torobotic arm 120 ofFIGS. 1 and 2 and showinginstrument 224 inserted throughguide body 202 to engagecalibration module 216.Plate 262 ofcalibration module 216 can be positionedopposite guide body 240 such thatplate 262 can be engaged byinstrument 224.Extension 264 can positionplate 262 first distance D1 frombottom surface 234.Wheel 282 can be configured to contactinstrument 224 distance D2 belowbottom surface 234. Distances D1 and D2 can be stored in memory of computing system 140 (e.g.,memory 622 ofFIG. 14 ormemories 1704 and 1707 ofFIG. 15 ). In the position ofinstrument 224 ofFIG. 7 , e.g., withtip 232 contactingplate 262, measuringdevice 204 can be calibrated or zeroed to set the distance oftip 232. frombottom surface 234. Calibration can comprise a user-interface function where a user ofsurgical system 100 engagescontrol device 222 or human interface devices 145 (FIG. 1 ) to record the location oftip 232 at the time of calibration. The location ofbottom surface 234 can be known by computingsystem 140 in the coordinate system ofsurgical system 100 due to, for example,surgical system 100 knowing the location ofrobotic arm 120. With measuringdevice 204 zeroed,computing system 140 can be set to know the location oftip 232 in the same coordinate system. Probe 220 can engage, e.g., contact,shaft 254 ofinstrument 224 to keep track of, e.g., determine and transmit tocomputing system 140, the position oftip 232 in the coordinate system asinstrument 224 is moved alongaxis 208 ininstrument holder 200. -
FIG. 8 is a side cross-sectional view ofinstrument holder 200 of FIG, 7 withcalibration module 216 removed.Instrument 224 is moved further intopassage 226 relative to the position ofinstrument 224 ofFIG. 8 .Control device 222 can comprisehousing 292,tube 294,sensor 296,power module 300 andcommunication device 302.Power module 300 can comprise any suitable device for providing electric power to controldevice 222. In examples,power module 300 can comprise a battery or an AC-to-DC converter for receiving power from an electrical outlet.Communication device 302 can comprise any suitable device for receiving information fromsensor 296 and conveying the information to outside ofcontrol device 222. In examples,communication device 302 can include circuitry to perform wireless communications, such as low-energy Bluetooth, near-field communication (NFC), or IEEE 802.11 (Wi-Fi). In other examples,communication device 302 can communicate via wired connection to robotic arm at communication port 306 (FIG. 7 ), such as a cable connector that can be additionally used for other devices, such as force sensor 180.Sensor 296 can be configured to emit signal S to contactwheel 282. Signal S can be configured as a reader device to read hash marks 298 onwheel 282 Hash marks 298 can comprise colored markings, e.g., darkened lines, or physical structures, e.g., depressions or protrusions. The circumferential distance between hash marks 298 can be stored in memory ofcomputing system 140, for example, so thatsurgical system 100 can correlate rotational movement ofwheel 282 with linear translation ofinstrument 224 alongaxis 208. In examples,sensor 296 can comprise a laser emitter.Sensor 296 can be configured to count hash marks 298 as hash marks 298 pass through signal S aswheel 282 rotates. -
FIG. 9 is a schematic illustration showingmeasuring device 204 ofinstrument holder 200 ofFIG. 3 being calibrated in an operating room environment relative tosurgeon 310 andpatient 312.FIG. 9 illustrates the configuration ofinstrument holder 200 ofFIG. 7 and shows thatcalibration module 216 and measuringdevice 204 can remain attached toinstrument holder 200 to perform the calibration procedure.Robotic arm 120 can be positioned relative topatient 312 to alignaxis 208 withpatient 312 is a desired orientation.Surgeon 310 can manually pushinstrument 224 down to engageplate 262 ofcalibration module 216 to perform the calibration or zeroing procedure. In other examples,calibration module 216 can be attached torobotic arm 120 and calibrated beforerobotic arm 120positions instrument holder 200 in place. -
FIG. 10 is a schematic illustration showingmeasuring device 204 ofinstrument holder 200 ofFIG. 9 being used to guide aninstrument 224 into engagement withpatient 312 in the operating room environment.FIG. 10 illustrates the configuration ofinstrument holder 200 ofFIG. 8 and shows thatcalibration module 216 can be removed to allow measuringdevice 204 to be used to perform a medical procedure. After the calibration procedure has been performed,calibration module 216 can be removed frominstrument holder 200.Robotic arm 120 can holdinstrument holder 200 in place along the desired trajectory ofaxis 208. Thus,surgeon 310 can manually push instrument into contact with or intopatient 312. Measuringdevice 204 can be used bysurgeon 310 to determine, viasurgical system 100, the location oftip 232.Surgeon 310 can then advanceinstrument 224 according to a surgical plan to a desired depth. For example,surgeon 310 can consulthuman interface devices 145 to read a distance that tip 232 has been extended, or to view directly, in real time, the insertion of the instrument into a 3D model based on medical images. As discussed below, advancement ofinstrument 224 can additionally be automated, such as bysurgeon 310 entering into human interface devices 145 a distance fortip 232 to be moved and a motorized version of measuringdevice 204, such as described below, can be used to moveinstrument 224. -
FIG. 11 is a schematic illustration showing an additional embodiment of the instrument holders described herein includingmultiple probes wheels Probes sensor 296, though not illustrated for simplicity. Multiple probes can be included ininstrument holder 200 to provide redundancy. Furthermore, multiple probes can facilitate centering ofinstrument 224 onaxis 208, such as by eliminating potential for a single probe to pushinstrument 224 off alignment withaxis 208.FIG. 11 illustrates multiple probes of the same type, i.e., each including a wheel for direct mechanical engagement ofinstrument 224. However, any of the probes or measuring devices described herein can be combined in various combination to provide redundancy and stabilization toinstrument 224. -
FIG. 12 is a schematic illustration of mechanicalposition measuring device 320 for use with compatible instruments via engagement of a rack and pinion engagement system. Measuringdevice 320 can comprisemotor 321 andencoder 322, as well aswheel 282B andaxle 284B. The rack and pinion engagement system can includerack gear teeth 324 located oninstrument 224B andpinion gear teeth 326 located onwheel 282B.Wheel 282B andaxle 284B can be configured to operate within a probe similar to operation ofwheel 282 andaxle 284 inprobe 220. As such,wheel 282B can be configured to rotate about an axis perpendicular toaxis 208.Instrument 224B can be pushed down intopassage 226 to mechanically engagewheel 282B.Passage 226 can include a cut-out or channel to accommodateteeth 324.Teeth 324 can engageteeth 326 ofwheel 282B to become enmeshed. As such, rather than a frictional engagement, direct pushing ofwheel 282B can occur via pushing ofteeth 324 againstteeth 326.Encoder 322 can be included inwheel 282B oraxle 284B to record the rotational movement ofwheel 282B. Such rotational movement can be correlated to the linear translation ofinstrument 224B to determine the position of the tip ofinstrument 224B, as is described herein.Encoder 232 can comprise an electro-mechanical rotary encoder device where the angular position or motion ofaxle 284 is converted to analog or digital output signals. An encoder, such asencoder 232, can additionally be provided withinwheel 282 ofFIGS. 3 and 6-8 to provide redundancy withsensor 296 or as an alternative tosensor 296. - In additional examples,
wheel 282B can be driven bymotor 320.Motor 320 can be used to moveinstrument 224B automatically without intervention fromsurgeon 310. For example, a button or switch oncontrol device 222 orhuman interface devices 145 can be actuated bysurgeon 310 to activate movement ofmotor 320 and cause linear movement ofinstrument 224B.Motor 320 can additionally be included in the other examples of instrument holders and measuring devices described herein. -
FIG. 13 is a flowchart illustrating actions or steps of methods ortechnique 500 for assemblinginstrument holder 200 with measuringdevice 204 and roboticsurgical system 100, calibrating measuringdevice 204 withcalibration module 216 and usinginstrument holder 200 with measuringdevice 204. - At
step 502,instrument holder 200 can be assembled withrobotic arm 120. For example, guidebody 202 can be attached toextension 210 usingfastener 304. - At
step 504, a position sensor can be attached toinstrument holder 200. For example, measuringdevice 204 can be attached to guidebody 202 by positioning mountingflange 242 inslot 278 onattachment body 218. Measuringdevice 204 can be secured by insertingfastener 217A intobore 276A, throughbore 244A and intobore 217B. - At
step 506,calibration module 216 can be attached toinstrument holder 200. For example,calibration module 216 can be attached to guidebody 202 by positioning mountingflange 242 inslot 266 oncoupling portion 260.Calibration module 216 can be secured by insertingfastener 217B intobore 268 and bore 244B. - At
step 508,instrument adapter 214 can be attached toinstrument holder 200. For example,adapter tube 248 can be inserted intopassage 206 withinguide tube 240.Instrument adapter 214 can be positioned so that stop flange 250 contactstop surface 246. - At
step 510,instrument 224 can be inserted intopassage 226 ofinstrument adapter 214.Instrument 224 can be positioned so thattip 232 remains withinpassage 226 aboveprobe 220 for calibration and later deployment towardpatient 312. - At
step 512,instrument 224 can be advanced withinpassage 226 until instrument contacts wheel 282 ofprobe 220. For example,instrument 224 can be advanced withinpassage 226 so thattip 232 engages and then movespast wheel 282 ofprobe 220.Shaft 254 ofinstrument 224 can remain in contact withwheel 282. In particular, movement ofshaft 254 againstwheel 282 can cause rotation ofwheel 282 aboutaxle 284 via frictional engagement. - Thus, steps 502-512 can describe a method of assembling
instrument holder 200 torobotic arm 120, including a sub-method of assemblingmeasuring device 204,calibration module 216 andinstrument adapter 214 toinstrument holder 200. - At
step 514,instrument 224 can be advanced withinpassage 226 so thattip 232contacts calibration module 216. For example,shaft 254 can be advanced untiltip 232contacts plate 262. - At
step 516, the position ofinstrument 224 relative toinstrument holder 200 can be zeroed. For example, a user ofsystem 100 can press a button or activate a switch oncontrol device 222 orhuman interface devices 145. Thus, the position ofinstrument 224 andtip 232 can be recorded insurgical system 100 for referencing in the coordinate system ofrobotic arm 120.Calibration module 216 can be removed frominstrument holder 200 atstep 516. - Thus, steps 512-516 can describe a method of calibrating
measuring device 204. - At
step 518,robotic arm 120 can be positioned relative topatient 312 to positioninstrument holder 200 at a desired trajectory towardpatient 312. In additional examples,robotic arm 120 can be positioned before other steps of the method, such as beforesteps calibration module 216 andinstrument adapter 214 are coupled toinstrument holder 200. - At
step 520,instrument 224 can be translated withinpassage 226 alongaxis 208 towardpatient 312. Translation ofinstrument 224 can cause movement oftip 232 beyond the position of engagement withplate 262 whenplate 262 was attached.Wheel 282 can rotate an amount corresponding to the movement ofinstrument 224. For example, the linear translation ofinstrument 224 can correspond to an arc length about the circumference ofwheel 282. - At
step 522, a measurement ofwheel 282 can be obtained usingsensor 296.Sensor 296 can correlate the circumferential rotation ofwheel 282 to the linear distance thatinstrument 224 has traversed to determine a position oftip 232 relative to the zeroed position. Such position can be correlated back to the coordinate system ofsurgical system 100 via the known position ofrobotic arm 120 in the coordinate system. The mechanical measurement can alternatively, or additionally be taken, using an encoder, such asencoder 322, to directly electro-mechanically measure the position ofinstrument 224. - At
step 524, a medical procedure or a step of a medical procedure can be performed with instrument 2224 held in a desired orientation, such as an orientation according to a medical plan. - At
step 526,instrument 224 andinstrument adapter 214 can be removed frominstrument holder 200. Subsequently, other surgical tasks can be performed by attaching a different instrument adapter toinstrument holder 200, calibrating the different instrument with measuringdevice 204 andcalibration module 216, and movingrobotic arm 120 to a new position, such as by returning to step 506 or another step ofmethod 500. - Steps 518-526 can describe a method of performing a medical procedure using
instrument holder 200 and measuringdevice 204 to hold and track the position ofinstrument 224. -
FIG. 14 illustratessystem 600 for performing techniques described herein, in accordance with some embodiments.System 600 is an example of a system that can incorporatesurgical system 100 ofFIG. 1 .System 600 can include robotic surgical device 602 (e.g., robotic surgical device 115) coupled to instrument holder 604 (e.g., instrument holder 200), which may interact withtracking system 606. In other examples, the instrument holders described herein can be used without trackingsystem 606.Tracking system 606 can include trackingelement 608 andcamera 610. Instrument holder 604 can include measuring device 612 (e.g., measuring device 204).System 600 can includedisplay device 614, which can be used to displayuser interface 616.System 600 can include control system 618 (e.g., a robotic controller orcomputing system 140 ofFIG. 1 ), includingprocessor 620 andmemory 622. In an example,display device 614 can be coupled to one or more of roboticsurgical device 602,tracking system 606, orcontrol system 618. As such, data generated by measuringdevice 612 can be shared withcontrol system 618,tracking system 606 and an operator ofsystem 600 viadisplay device 614. In examples, measuringdevice 612 can be operated without input from trackingsystem 608 such that roboticsurgical device 602 can be positioned and tracked by 1) movement ofrobotic arm 120 within the native coordinate system ofrobotic arm 120 and 2) movement ofsurgical device 602 relative to instrument holder 604 usingmeasuring device 612. -
FIG. 15 illustrates a block diagram of anexample machine 1700 upon which any one or more of the techniques discussed herein may perform in accordance with some embodiments. For example,machine 1700 can comprisecomputing system 140 ofFIG. 1 .Machine 1700 can comprise an example of a controller forrobotic system 115 andsensors 1721 can include the measuring devices described herein, such as measuringdevice 204, and trackingelements such instructions 1724 can be executed byprocessor 1702 to generate and correlate position information to determine the position of a surgical instrument relative torobotic arm 120. For example, position information of measuring device 204 (e.g., sensor 1721) relating to the location oftip 232 relative to guidebody 202 can be stored inmain memory 1704 and accessed byprocessor 1702.Processor 1702 can also receive input (such as at input device 1712) relating to the position ofinstrument holder 200 relative torobotic arm 120 and store such information inmain memory 1704.Processor 1702 can further relate position information oftip 232. to the position information ofarm 120 to correlate the position oftip 232 torobotic arm 120, not justinstrument holder 200. As such, astip 232moves machine 1700 can continuously track and update the location oftip 232 relative torobotic arm 120 via measuringdevice 204 and, for example, display said position on display device 1710 (e.g., user interface devices 145). - In alternative embodiments,
machine 1700 may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment,machine 1700 may operate in the capacity of a server machine, a client machine, or both in server-client network environments. In an example,machine 1700 may act as a peer machine in peer-to-peer (P2P) (or other distributed) network environment.Machine 1700 may be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term “machine” shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), other computer cluster configurations. - Machine (e.g., computer system) 1700 may include hardware processor 1702 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof),
main memory 1704 andstatic memory 1706, some or all of which may communicate with each other via interlink (e.g., bus) 1708.Machine 1700 may further includedisplay unit 1710, alphanumeric input device 1712 (e.g., a keyboard), and user interface (UI) navigation device 1714 (e.g., a mouse). In an example,display unit 1710,input device 1712 andUI navigation device 1714 may be a touch screen display.Machine 1700 may additionally include storage device (e.g., drive unit) 1716, signal generation device 1718 (e.g., a speaker),network interface device 1720, and one ormore sensors 1721, such as a global positioning system (GPS) sensor, compass, accelerometer, or other sensor.Machine 1700 may includeoutput controller 1728, such as a serial (e.g., Universal Serial Bus (USB), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NEC), etc.) connection to communicate or control one or more peripheral devices (e.g., a printer, card reader, etc.). -
Storage device 1716 may include machine readable medium 1722 on which is stored one or more sets of data structures or instructions 1724 (e.g., software) embodying or utilized by any one or more of the techniques or functions described herein.Instructions 1724 may also reside, completely or at least partially, withinmain memory 1704, withinstatic memory 1706, or withinhardware processor 1702 during execution thereof bymachine 1700. In an example, one or any combination ofhardware processor 1702,main memory 1704,static memory 1706, orstorage device 1716 may constitute machine readable media. - While machine readable medium 1722 is illustrated as a single medium, the term “machine readable medium” may include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) configured to store the one or
more instructions 1724. The term “machine readable medium” may include any medium that is capable of storing, encoding, or carrying instructions for execution bymachine 1700 and thatcause machine 1700 to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions. Non-limiting machine readable medium examples may include solid-state memories, and optical and magnetic media. -
Instructions 1724 may further be transmitted or received overcommunications network 1726 using a transmission medium vianetwork interface device 1720 utilizing any one of a number of transfer protocols (e.g., frame relay, internet protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.). Example communication networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), mobile telephone networks (e.g., cellular networks), Plain Old Telephone (POTS) networks, and wireless data networks (e.g., Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards known as Wi-Fi®, IEEE 802.16 family of standards known as WiMax®), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, among others. In an example,network interface device 1720 may include one or more physical jacks (e.g., Ethernet, coaxial, or phone jacks) or one or more antennas to connect tocommunications network 1726. In an example,network interface device 1720 may include a plurality of antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) techniques. The term “transmission medium” shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution bymachine 1700, and includes digital or analog communications signals or other intangible medium to facilitate communication of such software. - The systems, devices and methods discussed in the present application can be useful in performing robotic-assisted surgical procedures that utilize robotic surgical arms that can be coupled to instrument holders used to precisely align trajectories of instruments relative to anatomy of a patient registered to the space of an operating room. The present disclosure describes adjustable instrument holders that can remain mounted to a robotic surgical arm throughout a surgical procedure. The adjustable instrument holders can be adjusted to hold instruments of different sizes, e.g., different diameters, without removing the instrument holder form the robotic arm. The adjustable instrument holders can be easily and quickly manipulated to remove a first instrument of a first size and insert a second instrument of a second size, thereby decreasing time for performing a surgical procedure. The adjustable instrument holders can include passages that have variable orifice sizes, e.g., variable diameters, formed by adjustable members, such as jaws or blades, that form adjustable jaws, chucks or diaphragms to align an instrument and hold an instrument along a trajectory. The adjustable instrument holders can include adjustment members that provide axial length along an axis of the trajectory to provide stability to the instrument. The adjustable instrument holders can additionally be easily and quickly assembled and disassembled for cleaning, sanitizing and sterilizing procedures.
- Example 1 can include or use subject matter such as an instrument holder system that can comprise a guide body comprising a first end, a second end, and a passage extending between the first and second ends along an axis to receive an instrument; and a mechanical or electro-mechanical measuring device comprising an attachment body for coupling to the guide body, and a probe configured to extend into a trajectory of the passage to contact the instrument and generate positional data.
- Example 2 can include, or can optionally be combined with the subject matter of Example 1, to optionally include a probe comprising a wheel configured to rotate about an axle. Example 3 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 or 2 to optionally include a probe further comprising a reader device configured to determine a rotational position of the wheel about the axle.
- Example 4 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 3 to optionally include a reader device comprising a laser, and a wheel comprising marks configured to be read by the laser.
- Example 5 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 4 to optionally include a reader device comprising an encoder embedded into the wheel or axle.
- Example 6 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 5 to optionally include a sliding bracket coupled to the wheel, the sliding bracket being adjustable relative to the axis, and a biasing member configured to push the sliding bracket toward the axis. Example 7 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 6 to optionally include a probe that further comprises a plurality of wheels each having an instrument contact surface, the instrument contact surfaces configured to surround the axis.
- Example 8 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 7 to optionally include a wheel having teeth.
- Example 9 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 8 to optionally include a motor configured to rotate the wheel.
- Example 10 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 9 to optionally include a control device coupled to the probe and configured to receive the positional data.
- Example 11 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 10 to optionally include a control device that comprises a transmitter configured to transmit the positional data via a signal to a surgical system. Example 12 can include, or can optionally be combined with the subject matter of one or any combination of Examples 1 through 11 to optionally include a transmitter that comprises a wireless signal transmitter.
- Example 13 can include, or can optionally be combined with the subject matter of Example 12, to optionally include a guide body further comprising an instrument adapter configured to adjust a size of the passage.
- Example 14 can include, or can optionally be combined with the subject matter of Example 13, to optionally include a calibration module comprising a first portion configured to couple to the second end of the guide body, and a plate extending from the first portion to oppose the second end of the guide body, wherein the plate is located a fixed distance from the second end of the guide body, a magnitude of the fixed distance being electronically stored in the control device.
- Example 15 can include or use subject matter such as a method of determining a position of a surgical instrument relative to an instrument holder for a robotic arm comprising inserting an instrument into a passage of the instrument holder, moving the instrument into contact with a sensing element mounted to the instrument holder, moving a tip of the instrument out of the instrument holder to cause movement of the sensing element, and correlating movements of the sensing element to distances the tip extends out of the instrument holder.
- Example 16 can include, or can optionally be combined with the subject matter of Example 15 to optionally include moving a tip of the instrument out of the instrument holder to cause movement of the sensing element by causing rotation of the sensing element.
- Example 17 can include, or can optionally be combined with the subject matter of one or any Examples 15 and 16 to optionally include biasing the sensing element toward an axial center of the passage. Example 18 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 17 to optionally include moving the instrument into contact with the sensing element by moving the instrument into frictional engagement with the sensing element or moving the instrument into meshed engagement with the sensing element.
- Example 19 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 18 to optionally include calibrating a zero position for the tip of the instrument relative to the instrument holder.
- Example 20 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 19 to optionally include calibrating the zero position for the tip by engaging the tip with a plate of a calibration module disposed opposite an outlet of the instrument holder.
- Example 21 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 20 to optionally include correlating movements of the sensing element to distances the tip extends out of the instrument holder by reading rotation of the sensing element with a reader configured to identify hash marks on the sensing element.
- Example 22 can include, or can optionally be combined with the subject matter of one or any combination of Examples 15 through 21 to optionally include correlating movements of the sensing element to distances the tip extends out of the instrument holder comprises reading rotation of a shaft of the sensing element with an encoder.
- Each of these non-limiting examples can stand on its own, or can be combined in various permutations or combinations with one or more of the other examples.
- The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventor also contemplates examples in which only those elements shown or described are provided. Moreover, the present inventor also contemplates examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.
- In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls.
- In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” in this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein,” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.
- Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples. An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, in an example, the code can be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMS), read only memories (ROMs), and the like.
- The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. :It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a. separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
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- 2020-10-19 CA CA3157125A patent/CA3157125A1/en active Pending
- 2020-10-19 WO PCT/EP2020/079397 patent/WO2021074450A1/en unknown
- 2020-10-19 EP EP20797414.8A patent/EP4044953A1/en active Pending
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CN113995510A (en) * | 2021-11-16 | 2022-02-01 | 武汉联影智融医疗科技有限公司 | Surgical navigation cart, surgical auxiliary robot system and method for avoiding head collision |
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US20230241775A1 (en) * | 2022-02-02 | 2023-08-03 | Mazor Robotics, Ltd. | Robotic arm guide as a depth stop |
Also Published As
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CN114650784A (en) | 2022-06-21 |
WO2021074450A1 (en) | 2021-04-22 |
EP4044953A1 (en) | 2022-08-24 |
CA3157125A1 (en) | 2021-04-22 |
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